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Chen LP, Singh-Verdeflor K, Kelly MM, Sklansky DJ, Shadman KA, Edmonson MB, Zhao Q, DeMuri GP, Coller RJ. Disparities in COVID-19 vaccine intentions, testing and trusted sources by household language for children with medical complexity. PLoS One 2024; 19:e0305553. [PMID: 38875256 DOI: 10.1371/journal.pone.0305553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/02/2024] [Indexed: 06/16/2024] Open
Abstract
OBJECTIVES Children with medical complexity experienced health disparities during the coronavirus disease 2019 (COVID-19) pandemic. Language may compound these disparities since people speaking languages other than English (LOE) also experienced worse COVID-19 outcomes. Our objective was to investigate associations between household language for children with medical complexity and caregiver COVID-19 vaccine intentions, testing knowledge, and trusted sources of information. METHODS This cross-sectional survey of caregivers of children with medical complexity ages 5 to 17 years was conducted from April-June 2022. Children with medical complexity had at least 1 Complex Chronic Condition. Households were considered LOE if they reported speaking any language other than English. Multivariable logistic regression examined associations between LOE and COVID-19 vaccine intentions, interpretation of COVID-19 test results, and trusted sources of information. RESULTS We included 1,338 caregivers of children with medical complexity (49% response rate), of which 133 (10%) had household LOE (31 total languages, 58% being Spanish). There was no association between household LOE and caregiver COVID-19 vaccine intentions. Caregivers in households with LOE had similar interpretations of positive COVID-19 test results, but significantly different interpretations of negative results. Odds of interpreting a negative test as expected (meaning the child does not have COVID-19 now or can still get the virus from others) were lower in LOE households (aOR [95% CI]: 0.56 [0.34-0.95]). Households with LOE were more likely to report trusting the US government to provide COVID-19 information (aOR [95% CI]: 1.86 [1.24-2.81]). CONCLUSION Differences in COVID-19 test interpretations based on household language for children with medical complexity were observed and could contribute to disparities in outcomes. Opportunities for more inclusive public health messaging likely exist.
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Affiliation(s)
- Laura P Chen
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Kristina Singh-Verdeflor
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Michelle M Kelly
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Daniel J Sklansky
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Kristin A Shadman
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - M Bruce Edmonson
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Qianqian Zhao
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Gregory P DeMuri
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Ryan J Coller
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
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Borgi A, Meftah K, Trabelsi I, Kyaw MH, Zaghden H, Bouafsoun A, Mezghani F, Missaoui N, Abdel Ali A, Essaddam L, Khemiri H, Haddad-Boubaker S, Boussetta K, Khemiri M, Ben Becher S, Boukthir S, Triki H, Menif K, Smaoui H. Retrospective Analysis of Clinical Characteristics and Disease Outcomes in Children and Adolescents Hospitalized Due to COVID-19 Infection in Tunisia. Viruses 2024; 16:779. [PMID: 38793660 PMCID: PMC11125722 DOI: 10.3390/v16050779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Due to low susceptibility of coronavirus disease of 2019 (COVID-19) in children, limited studies are available regarding COVID-19 in the pediatric population in Tunisia. The current study evaluated the incidence, clinical characteristics, and outcomes of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection among children hospitalized at Béchir Hamza Children's Hospital. A retrospective cohort analysis was conducted using the hospital database between March 2020 and February 2022 with children aged ≤15 years with SARS-CoV-2 infection (confirmed by RT-PCR). A total of 327 COVID-19 hospitalized patients with a mean age of 3.3 years were included; the majority were male. Neurological disease (20%) was the most common comorbidity, while fever (95.3%) followed by cough (43.7%) and dyspnea (39.6%) were the most frequent symptoms reported. Severe disease with oxygen requirement occurred in 30% of the patients; 13% were admitted in the Intensive Care Unit. The overall incidence rate of COVID-19 hospitalization (in Tunis governorates) was 77.02 per 100,000 while the inpatient case fatality rate was 5% in the study population. The most prevalent circulating variant during our study period was Delta (48.8%), followed by Omicron (26%). More than 45% of the study population were <6 months and one-fourth (n = 25, 26.5%) had at least one comorbidity. Thus, the study findings highlight the high disease burden of COVID-19 in infants.
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Affiliation(s)
- Aida Borgi
- Pediatric Intensive Care Unit, Children’s Hospital of Tunis, Tunis 1007, Tunisia; (A.B.); (K.M.)
| | - Khaoula Meftah
- Laboratory of Microbiology, Children’s Hospital of Tunis, Tunis 1007, Tunisia; (K.M.)
| | - Ines Trabelsi
- Pediatric Department B, Children’s Hospital of Tunis, Tunis 1007, Tunisia; (I.T.)
| | | | | | - Aida Bouafsoun
- Laboratory of Microbiology, Children’s Hospital of Tunis, Tunis 1007, Tunisia; (K.M.)
| | - Fatma Mezghani
- Pediatric Department A, Children’s Hospital of Tunis, Tunis 1007, Tunisia
| | - Nada Missaoui
- Pediatric Department C, Children’s Hospital of Tunis, Tunis 1007, Tunisia
| | - Alya Abdel Ali
- Department of Pediatrics and Emergency, Children’s Hospital of Tunis, Tunis 1007, Tunisia
| | - Leila Essaddam
- Department of Pediatrics and Emergency, Children’s Hospital of Tunis, Tunis 1007, Tunisia
| | - Haifa Khemiri
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur of Tunis, Tunis 1002, Tunisia
| | - Sondes Haddad-Boubaker
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur of Tunis, Tunis 1002, Tunisia
| | - Khedija Boussetta
- Pediatric Department B, Children’s Hospital of Tunis, Tunis 1007, Tunisia; (I.T.)
| | - Monia Khemiri
- Pediatric Department A, Children’s Hospital of Tunis, Tunis 1007, Tunisia
| | - Saida Ben Becher
- Department of Pediatrics and Emergency, Children’s Hospital of Tunis, Tunis 1007, Tunisia
| | - Samir Boukthir
- Pediatric Department C, Children’s Hospital of Tunis, Tunis 1007, Tunisia
| | - Henda Triki
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur of Tunis, Tunis 1002, Tunisia
| | - Khaled Menif
- Pediatric Intensive Care Unit, Children’s Hospital of Tunis, Tunis 1007, Tunisia; (A.B.); (K.M.)
| | - Hanen Smaoui
- Laboratory of Microbiology, Children’s Hospital of Tunis, Tunis 1007, Tunisia; (K.M.)
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3
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Louka M, Tatsi EB, Vassiliu S, Theoharis G, Straka K, Filippatos F, Dourdouna MM, Siahanidou T, Syriopoulou V, Michos A. The Soluble Urokinase Plasminogen Activator Receptor as a Severity Biomarker in Children With Acute COVID-19 or Multisystem Inflammatory Syndrome. Pediatr Infect Dis J 2024; 43:477-482. [PMID: 38251905 DOI: 10.1097/inf.0000000000004244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Elevated soluble urokinase plasminogen activator receptor (suPAR) has been associated with a poor prognosis in serious infections. The aim of this study was to evaluate the clinical value of suPAR in children with acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome (MIS-C). METHODS Serum suPAR was measured using the suPARnostic AUTO Flex enzyme-linked immunosorbent assay in hospitalized children with COVID-19, MIS-C, bacterial pneumonia, and healthy controls. RESULTS A total of 211 children with a mean (±SD) age of 6.9 ± 4.96 years were tested; with COVID-19: 59 (28%), MIS-C: 36 (17%), pneumonia: 78 (37%) and healthy controls: 38 (18%). In the acute phase, the levels of suPAR (mean ± SD) were: MIS-C: 8.11 ± 2.80 ng/mL, COVID-19: 4.91 ± 1.90 ng/mL, pneumonia: 4.25 ± 1.44 ng/mL and controls: 2.09 ± 0.47 ng/mL ( P < 0.001). Children with acute COVID-19 and a severe or moderate clinical presentation had higher values than those with mild symptoms: 5.79 ± 1.58 versus 5.40 ± 1.94 versus 3.19 ± 0.73 ng/mL, respectively ( P < 0.001). In the MIS-C group, children hospitalized in the intensive care unit and in need of mechanical ventilation had higher suPAR than those who were not admitted to an intensive care unit: 9.32 ± 3.06 versus 7.13 ± 2.19 ng/mL, respectively ( P = 0.023). In children with COVID-19 or MIS-C, a correlation was detected between suPAR values and length of hospitalization ( rs = 0.418, P < 0.001). CONCLUSIONS The findings suggest that suPAR may be a valuable biomarker of disease severity in children with COVID-19 or MIS-C. This could facilitate the identification of children in need of intensive anti-inflammatory treatment, as it has been shown in adults with severe COVID-19.
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Affiliation(s)
- Magdalini Louka
- From the First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens Greece
| | - Elizabeth Barbara Tatsi
- From the First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens Greece
- University Research Institute of Maternal and Child Health and Precision Medicine, Athens, Greece
| | - Sofia Vassiliu
- From the First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens Greece
| | - George Theoharis
- From the First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens Greece
| | - Kalliopi Straka
- Pediatric Intensive Care Unit, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Filippos Filippatos
- From the First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens Greece
| | - Maria Myrto Dourdouna
- From the First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens Greece
| | - Tania Siahanidou
- Neonatal Unit, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Vasiliki Syriopoulou
- From the First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens Greece
| | - Athanasios Michos
- From the First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens Greece
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4
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Ogilvie RP, Layton JB, Lloyd PC, Jiao Y, Djibo DA, Wong HL, Gruber JF, Parambi R, Deng J, Miller M, Song J, Weatherby LB, Peetluk L, Lo AC, Matuska K, Wernecke M, Bui CL, Clarke TC, Cho S, Bell EJ, Yang G, Amend KL, Forshee RA, Anderson SA, McMahill-Walraven CN, Chillarige Y, Anthony MS, Seeger JD, Shoaibi A. Effectiveness of BNT162b2 COVID-19 primary series vaccination in children aged 5-17 years in the United States: a cohort study. BMC Pediatr 2024; 24:276. [PMID: 38671379 PMCID: PMC11047006 DOI: 10.1186/s12887-024-04756-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND COVID-19 vaccines are authorized for use in children in the United States; real-world assessment of vaccine effectiveness in children is needed. This study's objective was to estimate the effectiveness of receiving a complete primary series of monovalent BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine in US children. METHODS This cohort study identified children aged 5-17 years vaccinated with BNT162b2 matched with unvaccinated children. Participants and BNT162b2 vaccinations were identified in Optum and CVS Health insurance administrative claims databases linked with Immunization Information System (IIS) COVID-19 vaccination records from 16 US jurisdictions between December 11, 2020, and May 31, 2022 (end date varied by database and IIS). Vaccinated children were followed from their first BNT162b2 dose and matched to unvaccinated children on calendar date, US county of residence, and demographic and clinical factors. Censoring occurred if vaccinated children failed to receive a timely dose 2 or if unvaccinated children received any dose. Two COVID-19 outcome definitions were evaluated: COVID-19 diagnosis in any medical setting and COVID-19 diagnosis in hospitals/emergency departments (EDs). Propensity score-weighted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with Cox proportional hazards models, and vaccine effectiveness (VE) was estimated as 1 minus HR. VE was estimated overall, within age subgroups, and within variant-specific eras. Sensitivity, negative control, and quantitative bias analyses evaluated various potential biases. RESULTS There were 453,655 eligible vaccinated children one-to-one matched to unvaccinated comparators (mean age 12 years; 50% female). COVID-19 hospitalizations/ED visits were rare in children, regardless of vaccination status (Optum, 41.2 per 10,000 person-years; CVS Health, 44.1 per 10,000 person-years). Overall, vaccination was associated with reduced incidence of any medically diagnosed COVID-19 (meta-analyzed VE = 38% [95% CI, 36-40%]) and hospital/ED-diagnosed COVID-19 (meta-analyzed VE = 61% [95% CI, 56-65%]). VE estimates were lowest among children 5-11 years and during the Omicron-variant era. CONCLUSIONS Receipt of a complete BNT162b2 vaccine primary series was associated with overall reduced medically diagnosed COVID-19 and hospital/ED-diagnosed COVID-19 in children; observed VE estimates differed by age group and variant era. REGISTRATION The study protocol was publicly posted on the BEST Initiative website ( https://bestinitiative.org/wp-content/uploads/2022/03/C19-VX-Effectiveness-Protocol_2022_508.pdf ).
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Affiliation(s)
| | - J Bradley Layton
- RTI Health Solutions, 3040 East Cornwallis Rd, PO Box 12194, Research Triangle Park, NC, 27709, USA.
| | | | | | | | - Hui Lee Wong
- US Food and Drug Administration, Silver Spring, MD, USA
| | | | | | - Jie Deng
- Optum Epidemiology, Boston, MA, USA
| | | | | | | | | | | | | | | | - Christine L Bui
- RTI Health Solutions, 3040 East Cornwallis Rd, PO Box 12194, Research Triangle Park, NC, 27709, USA
| | | | - Sylvia Cho
- US Food and Drug Administration, Silver Spring, MD, USA
| | | | | | | | | | | | | | | | - Mary S Anthony
- RTI Health Solutions, 3040 East Cornwallis Rd, PO Box 12194, Research Triangle Park, NC, 27709, USA
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5
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Liu TL, Hsiao RC, Chou WJ, Yen CF. Prospective and Cross-Sectional Factors Predicting Caregiver Motivation to Vaccinate Children with Attention-Deficit/Hyperactivity Disorder against COVID-19: A Follow-Up Study. Vaccines (Basel) 2024; 12:450. [PMID: 38793701 PMCID: PMC11125857 DOI: 10.3390/vaccines12050450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
Adolescents with attention-deficit/hyperactivity disorder (ADHD) have higher risks of contracting COVID-19 and worse outcomes compared with adolescents without ADHD. The most effective method of preventing infection is vaccination. This follow-up study explored the prospective and cross-sectional factors influencing caregiver willingness to vaccinate children with ADHD against COVID-19. Baseline data on caregiver demographics, affiliate stigma, parenting stress, emotional difficulties, beliefs regarding the causes of ADHD, and ADHD symptoms were collected prior to the outbreak of the COVID-19 pandemic in Taiwan. At follow-up, the study assessed caregiver willingness to vaccinate children with ADHD, the challenges caregivers faced in parenting during the pandemic, and ADHD symptoms. The results revealed that caregiver age at baseline was positively associated with a willingness to vaccinate children against COVID-19 at follow-up. By contrast, the belief that ADHD resulted from failures in parental discipline at baseline was negatively associated with caregiver willingness to vaccinate. Parenting challenges were also negatively associated with caregiver willingness to vaccinate. Therefore, the age of caregivers, beliefs about the causes of ADHD, and parenting challenges during the pandemic should be considered when developing interventions to enhance caregiver willingness to vaccinate children with ADHD.
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Affiliation(s)
- Tai-Ling Liu
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80754, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Ray C. Hsiao
- Department of Psychiatry, Seattle Children’s, Seattle, WA 98195, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA 98105, USA
| | - Wen-Jiun Chou
- Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung 83341, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80754, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- College of Professional Studies, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
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Pérez-Ardanaz B, Gutiérrez-Rodríguez L, Pelaez-Cantero MJ, Morales-Asencio JM, Gómez-González A, García-Piñero JM, Lupiañez-Perez I. Healthcare service use for children with chronic complex diseases: A longitudinal six-year follow-up study. J Pediatr Nurs 2024:S0882-5963(24)00119-2. [PMID: 38594165 DOI: 10.1016/j.pedn.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE The objective was analysed the patterns use of healthcare services of this population and the influence of their clinical and sociodemographic characteristics. DESIGN AND METHODS A six-year longitudinal follow-up study was performed to evaluate the annual healthcare resources use and clinical data among children with complex chronic diseases in Spain between 2015 and 2021. The sample trends in healthcare usage and the associated factors were analysed using ANCOVA and multivariable linear regression models. RESULTS Patients had high attendance during the follow-up period, with >15 episodes year. This trend decreased over time, especially in children with oncological diseases compared with other diseases (F (16.75; 825.4) = 32.457; p < 0.001). A multivariable model showed that children with a greater number of comorbidities (β = 0.17), shorter survival time (β = -0.23), who had contact with the palliative care unit (β = 0.16), and whose mothers had a higher professional occupation (β = 0.14), had a greater use of the healthcare system. CONCLUSIONS Children with a higher number of comorbidities and the use of medical devices made a greater frequentation of health services, showing a trend of decreasing use over time. Socioeconomic factors such as mothers' occupational status determine healthcare frequentation. These results suggest the existence of persistent gaps in care coordination sustained over time. PRACTICAL IMPLICATIONS Systematized and coordinated models of care for this population should consider the presence of inequalities in health care use.
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Affiliation(s)
- Bibiana Pérez-Ardanaz
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | - Laura Gutiérrez-Rodríguez
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | | | - José Miguel Morales-Asencio
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | - Alberto Gómez-González
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | - José Miguel García-Piñero
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Pediatric Intensive Care Unit, Hospital Materno-Infantil, Málaga, Spain
| | - Inmaculada Lupiañez-Perez
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
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7
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Gross K, Georgeades C, Bergner C, Van Arendonk KJ, Salazar JH. Preoperative Risk Factors and Postoperative Complications of COVID-Positive Children Requiring Urgent or Emergent Surgical Care. J Pediatr Surg 2024; 59:686-693. [PMID: 38104034 DOI: 10.1016/j.jpedsurg.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/16/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Preoperative COVID-19 testing protocols were widely implemented for children requiring surgery, leading to increased resource consumption and many delayed or canceled operations or procedures. This study using multi-center data investigated the relationship between preoperative risk factors, COVID-positivity, and postoperative outcomes among children undergoing common urgent and emergent procedures. METHODS Children (<18 years) who underwent common urgent and emergent procedures were identified in the 2021 National Surgical Quality Improvement Program Pediatric database. The outcomes of COVID-positive and non-COVID-positive (negative or untested) children were compared using simple and multivariable regression models. RESULTS Among 40,628 children undergoing gastrointestinal surgery (appendectomy, cholecystectomy), long bone fracture fixation, cerebrospinal fluid shunt procedures, gonadal procedures (testicular detorsion, ovarian procedures), and pyloromyotomy, 576 (1.4%) were COVID-positive. COVID-positive children had higher American Society of Anesthesiologists scores (p ≤ 0.001) and more frequently had preoperative sepsis (p ≤ 0.016) compared to non-COVID-positive children; however, other preoperative risk factors, including comorbidities, were largely similar. COVID-positive children had a longer length of stay than non-COVID-positive children (median 1.0 [IQR 0.0-2.0] vs. 1.0 [IQR 0.0-1.0], p < 0.001). However, there were no associations between COVID-19 positivity and overall complications, pulmonary complications, infectious complications, or readmissions. CONCLUSIONS Despite increased preoperative risk factors, COVID-positive children did not have an increased risk of postoperative complications after common urgent and emergent procedures. However, length of stay was greater for COVID-positive children, likely due to delays in surgery related to COVID-19 protocols. These findings may be applicable to future preoperative testing and surgical timing guidelines related to respiratory viral illnesses in children. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kendall Gross
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 999 N 92nd Street, Suite 320, Milwaukee, WI, 53226, USA
| | - Christina Georgeades
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 999 N 92nd Street, Suite 320, Milwaukee, WI, 53226, USA
| | - Carisa Bergner
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 999 N 92nd Street, Suite 320, Milwaukee, WI, 53226, USA
| | - Kyle J Van Arendonk
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 999 N 92nd Street, Suite 320, Milwaukee, WI, 53226, USA
| | - Jose H Salazar
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 999 N 92nd Street, Suite 320, Milwaukee, WI, 53226, USA.
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8
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Lockhart-Bouron M, Vanel N, Levy M, Briant AR, Javouhey E, Breinig S, Dina J, Caseris M, Angoulvant F, Leteurtre S, Recher M, Brossier DW. Severe acute respiratory syndrome coronavirus-2-related and imputable deaths in children: results from the French pediatric national registry. World J Pediatr 2024:10.1007/s12519-023-00791-x. [PMID: 38506979 DOI: 10.1007/s12519-023-00791-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/14/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for an important mortality rate worldwide. We aimed to evaluate the actual imputability of SARS-CoV-2 on the mortality rate associated with SARS-CoV-2-related illnesses in the pediatric intensive care unit (PICU). Secondary objectives were to identify risk factors for death. METHODS This national multicenter comparative study comprised all patients under 18 years old with positive SARS-CoV-2 polymerase chain reactions (PCRs) [acute corona virus disease 2019 (COVID-19) or incidental SARS-CoV-2 infection] and/or pediatric inflammatory multisystem syndrome (PIMS) recorded in the French PICU registry (PICURe) between September 1, 2021, and August 31, 2022. Included patients were classified and compared according to their living status at the end of their PICU stay. Deceased patients were evaluated by four experts in the field of pediatric infectiology and/or pediatric intensive care. The imputability of SARS-CoV-2 as the cause of death was classified into four categories: certain, very probable, possible, or unlikely, and was defined by any of the first three categories. RESULTS There were 948 patients included of which 43 died (4.5%). From this, 26 deaths (67%) could be attributed to SARS-CoV-2 infection, with an overall mortality rate of 2.8%. The imputability of death to SARS-CoV-2 was considered certain in only one case (0.1%). Deceased patients suffered more often from comorbidities, especially heart disease, neurological disorders, hematological disease, cancer, and obesity. None of the deceased patients were admitted for pediatric inflammatory multisystem syndrome (PIMS). Mortality risk factors were male gender, cardiac comorbidities, cancer, and acute respiratory distress syndrome. CONCLUSIONS SARS-CoV-2 mortality in the French pediatric population was low. Even though the imputability of SARS-CoV-2 on mortality was considered in almost two-thirds of cases, this imputability was considered certain in only one case.
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Affiliation(s)
- Marguerite Lockhart-Bouron
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | - Noémie Vanel
- Pediatric Intensive Care Unit, CHU de Marseille, Marseille, France
| | - Michael Levy
- Pediatric Intensive Care Unit, CHU Robert-Debré, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris-Cité, Paris, France
| | - Anaïs R Briant
- Biostatistics and Clinical Research Unit, CHU de Caen Normandie, 14000, Caen, France
| | | | - Sophie Breinig
- Neonatal and Pediatric Intensive Care Unit, Children's Hospital, Toulouse, France
| | - Julia Dina
- Virology Department, INSERM U1311 Dynamicure, Univ CAEN Normandie, CHU de Caen, 14000, Caen, France
- Medical School, Université Caen Normandie, 14000, Caen, France
| | - Marion Caseris
- Department of Pediatrics, CHU Robert-Debré, Assistance Publique Hôpitaux de Paris, Paris, France
| | - François Angoulvant
- Department Women-Mother-Child, Service of Pediatrics, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Stéphane Leteurtre
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | - Morgan Recher
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | - David W Brossier
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France.
- Medical School, Université Caen Normandie, 14000, Caen, France.
- Pediatric Intensive Care Unit, Réanimation Et Soins Intensifs Pédiatriques, CHU de CAEN, Avenue de La Côte de Nacre, 14000, Caen, France.
- CHU Sainte Justine Research Center, Montréal, Canada.
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Yuan L, Sun C, Zeng Z, Wang H. Children aged 0-14 years had a far lower mortality risk during the entire COVID-19 pandemic in four major industrial countries: an observational study. Eur J Pediatr 2024:10.1007/s00431-024-05522-6. [PMID: 38502322 DOI: 10.1007/s00431-024-05522-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 02/29/2024] [Accepted: 03/11/2024] [Indexed: 03/21/2024]
Abstract
The purpose of this study is to describe the morbidity and mortality of children during the entire COVID-19 pandemic. Age-disaggregated data of 108,003,741 cases and 560,426 deaths were collected from Canada, France, Germany, and Italy. The number of cases and deaths per million people per week, as well as case fatality rates (CFRs), were calculated for patients aged 0-14 and ≥ 15 years. During the first pandemic period in the four countries, starting from weeks 4 to 11 (in 2020) and ending at week 22 (in 2021), the number of deaths per million people per week and the CFRs in the ≥ 15 years age group were 500 to 2513 and 442 to 1662 times greater, respectively, than those in the 0-14 years age group. The number of deaths per million people per week was significantly lower in the first pandemic period than in the second pandemic period, which started at week 23 (2021) and ended from week 22 to week 25 (2023). During the second pandemic period in the four countries, the disparities between the ≥ 15 years and 0-14 years age groups decreased, and the number of deaths per million people per week in the ≥ 15 years age group was 76 to 180 times greater than it in the 0-14 years age group. CONCLUSION Children aged 0-14 years had a far lower mortality risk during the entire COVID-19 pandemic, and the impact of viral variants and/or vaccination on the mortality rate is difficult to distinguish. WHAT IS KNOWN • Although extensive studies have focused on COVID-19-induced mortality, most of them are provisional reports performed during the unfolding of the pandemic and provide imprecise conclusion. WHAT IS NEW • We described the morbidity and mortality for children aged 0-14 years using complete survey data recorded during the entire COVID-19 pandemic. • The number of deaths per million people per week was far lower in children aged 0-14 years, while the number of deaths per million people per week in children aged 0-14 years was significantly higher in the second period which starting from week 23 (2021) and ending at week 22 to 25 (2023) than in the first period which starting from week 1 to 11 (2020) and ending at week 22 (2021).
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Affiliation(s)
- Lang Yuan
- Department of Pulmonology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, People's Republic of China
| | - Chao Sun
- Department of Pulmonology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, People's Republic of China.
| | - Zeyu Zeng
- Department of Pulmonology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, People's Republic of China
| | - Haojie Wang
- Department of Pulmonology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, People's Republic of China
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10
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Duan C, Liu L, Wang T, Wang G, Jiang Z, Li H, Zhang G, Ye L, Li C, Cao Y. Evidence linking COVID-19 and the health/well-being of children and adolescents: an umbrella review. BMC Med 2024; 22:116. [PMID: 38481207 PMCID: PMC10938697 DOI: 10.1186/s12916-024-03334-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 03/04/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Experiences during childhood and adolescence have enduring impacts on physical and mental well-being, overall quality of life, and socioeconomic status throughout one's lifetime. This underscores the importance of prioritizing the health of children and adolescents to establish an impactful healthcare system that benefits both individuals and society. It is crucial for healthcare providers and policymakers to examine the relationship between COVID-19 and the health of children and adolescents, as this understanding will guide the creation of interventions and policies for the long-term management of the virus. METHODS In this umbrella review (PROSPERO ID: CRD42023401106), systematic reviews were identified from the Cochrane Database of Systematic Reviews; EMBASE (OvidSP); and MEDLINE (OvidSP) from December 2019 to February 2023. Pairwise and single-arm meta-analyses were extracted from the included systematic reviews. The methodological quality appraisal was completed using the AMSTAR-2 tool. Single-arm meta-analyses were re-presented under six domains associated with COVID-19 condition. Pairwise meta-analyses were classified into five domains according to the evidence classification criteria. Rosenberg's FSN was calculated for both binary and continuous measures. RESULTS We identified 1551 single-arm and 301 pairwise meta-analyses from 124 systematic reviews that met our predefined criteria for inclusion. The focus of the meta-analytical evidence was predominantly on the physical outcomes of COVID-19, encompassing both single-arm and pairwise study designs. However, the quality of evidence and methodological rigor were suboptimal. Based on the evidence gathered from single-arm meta-analyses, we constructed an illustrative representation of the disease severity, clinical manifestations, laboratory and radiological findings, treatments, and outcomes from 2020 to 2022. Additionally, we discovered 17 instances of strong or highly suggestive pairwise meta-analytical evidence concerning long-COVID, pediatric comorbidity, COVID-19 vaccines, mental health, and depression. CONCLUSIONS The findings of our study advocate for the implementation of surveillance systems to track health consequences associated with COVID-19 and the establishment of multidisciplinary collaborative rehabilitation programs for affected younger populations. In future research endeavors, it is important to prioritize the investigation of non-physical outcomes to bridge the gap between research findings and clinical application in this field.
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Affiliation(s)
- Chengchen Duan
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
| | - Liu Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Tianyi Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
| | - Guanru Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhishen Jiang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
| | - Honglin Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Gaowei Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Li Ye
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chunjie Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Evidence-Based Stomatology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yubin Cao
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China.
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
- Department of Evidence-Based Stomatology, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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11
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de Farias ECF, Pavão Junior MJC, de Sales SCD, do Nascimento LMPP, Pavão DCA, Pinheiro APS, Pinheiro AHO, Alves MCB, Ferraro KMMM, Aires LFQ, Dias LG, Machado MMM, Serrão MJD, Gomes RR, de Moraes SMP, Moura GMG, de Sousa AMB, Pontes GCL, Carvalho RDFP, Silva CTC, Lemes G, da C G Diniz B, Chermont AG, de Almeida KFS, Saraty SB, Maia MLF, Lima MRC, Carvalho PB, de B Braga R, de O Harada K, Justino MCA, Clemente G, Terreri MT, Monteiro MC. Factors associated to mortality in children with critical COVID-19 and multisystem inflammatory syndrome in a resource-poor setting. Sci Rep 2024; 14:5539. [PMID: 38448485 PMCID: PMC10918095 DOI: 10.1038/s41598-024-55065-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/20/2024] [Indexed: 03/08/2024] Open
Abstract
SARS-CoV-2 infection in children is usually asymptomatic/mild. However, some patients may develop critical forms. We aimed to describe characteristics and evaluate the factors associated to in-hospital mortality of patients with critical COVID-19/MIS-C in the Amazonian region. This multicenter prospective cohort included critically ill children (1 mo-18 years old), with confirmed COVID-19/MIS-C admitted to 3 tertiary Pediatric Intensive Care Units (PICU) in the Brazilian Amazon, between April/2020 and May/2023. The main outcome was in-hospital mortality and were evaluated using a multivariable Cox proportional regression. We adjusted the model for pediatric risk of mortality score version IV (PRISMIV) score and age/comorbidity. 266 patients were assessed with 187 in the severe COVID-19 group, 79 included in the MIS-C group. In the severe COVID-19 group 108 (57.8%) were male, median age was 23 months, 95 (50.8%) were up to 2 years of age. Forty-two (22.5%) patients in this group died during follow-up in a median time of 11 days (IQR, 2-28). In the MIS-C group, 56 (70.9%) were male, median age was 23 months and median follow-up was 162 days (range, 3-202). Death occurred in 17 (21.5%) patients with a median death time of 7 (IQR, 4-13) days. The mortality was associated with higher levels of Vasoactive Inotropic-Score (VIS), presence of acute respiratory distress syndrome (ARDS), higher levels of Erythrocyte Sedimentation Rate, (ESR) and thrombocytopenia. Critically ill patients with severe COVID-19 and MIS-C from the Brazilian Amazon showed a high mortality rate, within 12 days of hospitalization.
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Affiliation(s)
- Emmerson C F de Farias
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil.
- Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, 7th Floor, St. Bernal do Couto, 988 - Umarizal, Belém, PA, 66055-080, Brazil.
| | - Manoel J C Pavão Junior
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Susan C D de Sales
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Luciana M P P do Nascimento
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Dalila C A Pavão
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Anna P S Pinheiro
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Andreza H O Pinheiro
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Marília C B Alves
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Kíssila M M M Ferraro
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Larisse F Q Aires
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Luana G Dias
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Mayara M M Machado
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Michaelle J D Serrão
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Raphaella R Gomes
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Sara M P de Moraes
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Gabriella M G Moura
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Adriana M B de Sousa
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Gabriela C L Pontes
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Railana D F P Carvalho
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Cristiane T C Silva
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Guilherme Lemes
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Bruna da C G Diniz
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Aurimery G Chermont
- Medical School, Medical Science Institute, Federal University of Pará/UFPA, Belém, PA, Brazil
| | - Kellen F S de Almeida
- Medical School, Medical Science Institute, Federal University of Pará/UFPA, Belém, PA, Brazil
| | - Salma B Saraty
- Division of Pediatric Intensive Care, Department of Pediatrics, Pronto Socorro Municipal Mário Pinotti's Hospital, Belém, PA, Brazil
| | - Mary L F Maia
- Division of Pediatric Intensive Care, Department of Pediatrics, Pronto Socorro Municipal Mário Pinotti's Hospital, Belém, PA, Brazil
| | - Miriam R C Lima
- Division of Pediatric Intensive Care, Department of Pediatrics, Pronto Socorro Municipal Mário Pinotti's Hospital, Belém, PA, Brazil
| | - Patricia B Carvalho
- Division of Pediatric Intensive Care, Departament of Pediatrics, Fundação Hospital das Clínicas Gaspar Viana, Belém, PA, Brazil
| | - Renata de B Braga
- Division of Pediatric Intensive Care, Departament of Pediatrics, Fundação Hospital das Clínicas Gaspar Viana, Belém, PA, Brazil
| | - Kathia de O Harada
- Division of Pediatric Intensive Care, Departament of Pediatrics, Fundação Hospital das Clínicas Gaspar Viana, Belém, PA, Brazil
| | - Maria C A Justino
- Instituto Evandro Chagas, Virology Section, Health Surveillance Secretariat, Brazilian Ministry of Health, Ananindeua, PA, Brazil
| | - Gleice Clemente
- Division of Pediatric Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Maria Teresa Terreri
- Division of Pediatric Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Marta C Monteiro
- Pharmaceutical Science Post-Graduation Program and Neuroscience and Cell Biology Graduate Program, Health Science Institute, Federal University of Pará/UFPA, Belém, PA, Brazil
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12
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Klingensmith LM, Goel S, Kampalath VN, Cohn KA. Clinical Outcomes of Children With COVID-19 by SARS-CoV-2 Strain: A Cohort Study. Pediatr Emerg Care 2024; 40:243-248. [PMID: 37665790 DOI: 10.1097/pec.0000000000003034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
OBJECTIVE We sought to investigate the disease outcomes and predictors of severe outcomes among children infected with the Delta variant of SARS-CoV-2 compared with pre-Delta strains. METHODS Single-center retrospective cohort study in an emergency department located within an urban academic children's hospital. Patients included children (0-18 years) who tested positive for SARS-CoV-2. Main outcomes measured include need for hospital admission or COVID-directed therapies. RESULTS There was a trend toward decreased hospital admission and no significant difference in the severity of outcomes in the Delta cohort relative to the pre-Delta cohort. The Delta cohort had lower odds of hospital admission (odds ratio [OR], 0.79; 95% confidence interval [CI], 0.51-1.23), but the result was not statistically significant. Logistic regression analyses showed that overall, age 1 to 4 years (OR, 2.35; 95% CI, 1.23-4.57) and public insurance (OR, 1.80, 95% CI, 1.08-3.01) were predictors of hospital admission. Within the Delta cohort, the presence of any comorbidity increased the odds of admission (OR, 2.52; 95% CI, 1.09-6.04). Black children had lower odds of admission than white children (overall OR, 0.53; 95% CI, 0.31-0.90; pre-Delta OR, 0.50; 95% CI, 0.26-0.95). CONCLUSIONS The severity of measured disease outcomes was similar in pediatric patients when comparing children infected with the pre-Delta and Delta variants of SARS-CoV-2, even among children with comorbidities once adjusting for acuity.Ongoing research is essential to determine disease severity and risk for children with comorbidities because SARS-CoV-2 continues to mutate, including with Omicron subvariants.
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Affiliation(s)
| | - Swati Goel
- From the Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Vinay N Kampalath
- Pediatrics Division, Emergency Medicine, Children's Hospital of Philadelphia, PA
| | - Keri A Cohn
- Pediatrics Division, Emergency Medicine, Children's Hospital of Philadelphia, PA
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13
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Zarth K, Holand BL, Zoche E, Schaan CW, Lukrafka JL, Bosa VL. Nutritional risk and functionality of children and adolescents hospitalized with COVID-19. Eur J Pediatr 2024; 183:1223-1230. [PMID: 38087095 DOI: 10.1007/s00431-023-05274-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/29/2023] [Accepted: 10/08/2023] [Indexed: 01/10/2024]
Abstract
To evaluate the association between nutritional risk and functionality of children and adolescents hospitalized with COVID-19 at admission and discharge. METHODS Retrospective cross-sectional study with patients under 19 years old, positive for SARS-COV-2 by RT-PCR test, from February 2020 to May 2022. The STRONGKids screening (Screening Tool Risk On Nutritional Status and Growth) was used to assess nutritional risk on hospital admission and the Functional Status Scale (FSS-Brazil) to determine the functionality of patients on admission and discharge. Data was collected from hospital medical records. Poisson regressions with crude robust variance were used to test the association between nutritional risk and functional status at admission, with adjustments for the age, length of stay, and presence of complex chronic conditions. RESULTS Of the 217 patients, 55.7% (n = 121) were boys with a median age of 6 years (IQ 0-12), 58.5% (n = 127) had at least one complex chronic condition, 64% (n = 139) had medium/high nutritional risk, and 23.9% (n = 52) had some degree of dysfunctionality upon admission and 14.6% (n = 31) upon discharge. By associating STRONGKids and the FSS-Brasil of hospital admission, it was observed that children with low nutritional risk had a mean global FSS lower (6.4 ± 0.7) than children with medium/high nutritional risk (7. 7 ± 2.8; p < 0.001). Children with low nutritional risk on admission also had a lower mean (6.1 ± 0.59) on the FSS at hospital discharge than children with medium/high nutritional risk (7.1 ± 2.5; p < 0.001). After adjustments, it was identified that the addition of one STRONGKids point increases by 36% (PR 1.36; 95%CI 1.15-1.62) the probability of the patient presenting some degree of functional impairment on admission. Conclusion: The study found a positive association between nutritional risk and functional impairment in hospitalized children and adolescents with COVID-19 on admission, even after adjusting for age, length of stay, and complex chronic conditions. Furthermore, patients with medium/high nutritional risk at admission also had worse functionality, both on admission and at discharge. WHAT IS KNOWN • Children and adolescents infected with COVID-19 tend to exhibit milder symptoms and lower hospitalization rates compared to adults, although severe cases and complications can occur. • A paucity of targeted investigations exists regarding the correlation between nutritional risk and functionality in children and adolescents with COVID-19. WHAT IS NEW • Children and adolescents with COVID-19 who presented with medium to high nutritional risk upon hospital admission demonstrated functional impairments, both at admission and hospital discharge.
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Affiliation(s)
- Kahena Zarth
- Graduate Program in Food, Nutrition and Health, Federal University of Rio Grande do Sul, 2400 Ramiro Barcelos Street, Porto Alegre, State of Rio Grande do Sul, 90035-002, Brazil
| | - Bruna Luiza Holand
- Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ester Zoche
- Nutrition Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Janice Luisa Lukrafka
- Department of Physical Therapy, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Vera Lúcia Bosa
- Graduate Program in Food, Nutrition and Health, Federal University of Rio Grande do Sul, 2400 Ramiro Barcelos Street, Porto Alegre, State of Rio Grande do Sul, 90035-002, Brazil.
- Nutrition Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
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14
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Lee KS, Kim YK, Choi YY, Choe YJ, Kim MH, Lee H. Risk Factors for Severe and Critical Coronavirus Disease 2019 in Children. Pediatr Infect Dis J 2024; 43:234-241. [PMID: 38241652 DOI: 10.1097/inf.0000000000004193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is generally mild in children; however, severe or critical cases may occur. In this nationwide study, we analyzed clinical manifestations in children diagnosed with severe acute respiratory syndrome coronavirus 2 to identify high-risk groups for severe or critical disease and compared the clinical features between the Delta- and Omicron-dominant periods. METHODS Data were retrieved from the National Health Insurance Service (NHIS) database and merged with the Korea Disease Control and Prevention Agency-COVID-19-NHIS cohort, which includes information on COVID-19 cases and vaccination records. We included individuals <20 years old diagnosed with COVID-19 during both periods (Delta: July 25, 2021-January 15, 2022; Omicron: January 16, 2022-March 31, 2022). RESULTS Proportion of severe or critical cases was higher during the Delta period than during the Omicron period. The Omicron period saw increased hospitalization for pneumonia and croup and increased likelihood of hospitalization for neurological manifestations. The risk of severe COVID-19 depended on age group (Delta: highest for 12-19 years; Omicron: 0-4 years). This risk was high in children with multiple complex chronic conditions during both periods and with obesity or asthma during the Delta but not during the Omicron period. Two-dose COVID-19 vaccination provided strong protection against severe disease in the Delta period (adjusted odds ratio: 0.20), with reduced effectiveness in the Omicron period (adjusted odds ratio: 0.91). However, it significantly reduced the risk of critical illness (adjusted odds ratio: 0.14). CONCLUSIONS These findings can facilitate identification of children at high risk of severe or critical COVID-19, who may require intensive medical support, and development of vaccination policies.
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Affiliation(s)
- Kyung-Shin Lee
- From the Public Health Research Institute, National Medical Center
| | - Ye Kyung Kim
- Department of Pediatrics, Konkuk University Medical Center
| | - Youn Young Choi
- From the Public Health Research Institute, National Medical Center
- Department of Pediatrics, National Medical Center
| | | | - Myoung-Hee Kim
- Center for Public Health Data Analytics, National Medical Center, Seoul, Republic of Korea
| | - Hyunju Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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15
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Üstündağ G, Karadag-Oncel E, Kara-Ulu N, Polat M, Salı E, Çakır D, Şahin A, Akaslan-Kara A, Kaçar P, Işık AD, Erdemli PC, Durmuş SY, Özdemir A, Çelik B, Sütçü M, Kara M, Kandemir-Gülmez T, Çelikyurt A, Ümit Z, Aktürk H, Arıkan K, Kaba Ö, Caymaz C, Bayhan C, Aygün D, Penezoğlu DN, Alataş ŞÖ, Özdemir H, Türel Ö, Akça M, Çelebi-Çongur E, Kepenekli E, Çelik Ü, Ecevit İZ, Belet N, Dalgıç N, Yılmaz N, Yılmaz D, Kuyucu N, Çiftçi E. COVID-19 in hospitalized infants aged under 3 months: multi-center experiences across Turkey. Eur J Pediatr 2024; 183:1153-1162. [PMID: 37971516 DOI: 10.1007/s00431-023-05329-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
To investigate coronavirus disease 2019 (COVID-19) in infants aged 0 to 3 months because there is currently a significant gap in the literature on the subject. A cross-sectional study was conducted with the involvement of 19 medical centers across Turkey and 570 infants. The majority of the patients were male (58.2%), and the three most common symptoms were fever (78.2%), cough (44.6%), and feeding intolerance (39.9%). The results showed that a small percentage of infants had positive blood (0.9%) or urine cultures (10.2%). Most infants presented with fever (78.2%). Children without underlying conditions (UCs) had mostly a complicated respiratory course and a normal chest radiography. Significant more positive urine culture rates were observed in infants with fever. A higher incidence of respiratory support requirements and abnormal chest findings were seen in infants with chronic conditions. These infants also had a longer hospital stay than those without chronic conditions. Conclusions: Our study discloses the clinical observations and accompanying bacterial infections found in infants aged under 3 months with COVID-19. These findings can shed light on COVID-19 in infancy for physicians because there is limited clinical evidence available. What is Known: • COVID-19 in infants and older children has been seen more mildly than in adults. • The most common symptoms of COVID-19 in infants are fever and cough, as in older children and adults. COVID-19 should be one of the differential diagnoses in infants with fever. What is New: • Although most infants under three months had fever, the clinical course was uneventful and respiratory complications were rarely observed in healthy children. • Infants with underlying conditions had more frequent respiratory support and abnormal chest radiography and stayed longer in the hospital.
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Affiliation(s)
- Gülnihan Üstündağ
- Izmir Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Izmir, Turkey
| | - Eda Karadag-Oncel
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.
| | - Nursel Kara-Ulu
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Gazi University, Ankara, Turkey
| | - Meltem Polat
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Gazi University, Ankara, Turkey
| | - Enes Salı
- Ümraniye Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Istanbul, Turkey
| | - Deniz Çakır
- Ümraniye Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Istanbul, Turkey
| | - Aslıhan Şahin
- Izmir Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Izmir, Turkey
| | - Aybüke Akaslan-Kara
- Izmir Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Izmir, Turkey
| | - Pelin Kaçar
- Izmir Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Izmir, Turkey
| | - Aylin Dizi Işık
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Marmara University, Istanbul, Turkey
| | - Pınar Canizci Erdemli
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Marmara University, Istanbul, Turkey
| | - Sevgi Yaşar Durmuş
- Clinic of Pediatric Infectious Disease, Kayseri City Hospital, Kayseri, Turkey
| | - Ahmet Özdemir
- Clinic of Neonatal Intensive Care Unit, Kayseri City Hospital, Kayseri, Turkey
| | - Binnaz Çelik
- Clinic of Pediatrics, Kayseri City Hospital, Kayseri, Turkey
| | - Murat Sütçü
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Istinye University, Istanbul, Turkey
| | - Manolya Kara
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Istinye University, Istanbul, Turkey
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Yeditepe University, Istanbul, Turkey
| | | | - Aydın Çelikyurt
- Faculty of Medicine, Department of Pediatrics, Koç University, Istanbul, Turkey
| | - Zühal Ümit
- Clinic of Pediatric Infectious Diseases, Manisa City Hospital, Manisa, Turkey
| | - Hacer Aktürk
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Koç University, Istanbul, Turkey
| | - Kamile Arıkan
- Clinic of Pediatric Infectious Diseases, Buca Seyfi Demirsoy Training and Research Hospital, Izmir, Turkey
| | - Özge Kaba
- Clinic of Pediatric Infectious Disease, Başakşehir Çam Ve Sakura City Hospital, Istanbul, Turkey
| | - Canan Caymaz
- Clinic of Pediatric Infectious Disease, Başakşehir Çam Ve Sakura City Hospital, Istanbul, Turkey
| | - Cihangül Bayhan
- Gülhane Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Ankara, Turkey
| | - Deniz Aygün
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Cerrahpaşa University Istanbul, Istanbul, Turkey
| | - Döndü Nilay Penezoğlu
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara University, Ankara, Turkey
| | - Şilem Özdem Alataş
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Halil Özdemir
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara University, Ankara, Turkey
| | - Özden Türel
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Bezmialem Foundation University, Istanbul, Turkey
| | - Mehtap Akça
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Mersin University, Mersin, Turkey
| | - Emel Çelebi-Çongur
- Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Istanbul, Turkey
| | - Eda Kepenekli
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Marmara University, Istanbul, Turkey
| | - Ümit Çelik
- Clinic of Pediatric Infectious Diseases, Adana City Hospital, Adana, Turkey
| | - İsmail Zafer Ecevit
- Gülhane Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Ankara, Turkey
| | - Nurşen Belet
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Nazan Dalgıç
- Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Istanbul, Turkey
| | - Nisel Yılmaz
- Department of Medical Microbiology, Izmir Tepecik Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Dilek Yılmaz
- Izmir Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Izmir, Turkey
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Izmir Katip Çelebi University, Izmir, Turkey
| | - Necdet Kuyucu
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Mersin University, Mersin, Turkey
| | - Ergin Çiftçi
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara University, Ankara, Turkey
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16
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Abbasi A, Ahmad K, Ferguson C, Soriano A, Calmelat R, Rossiter HB, Casaburi R, Stringer WW, Porszasz J. Lack of effect of an in-line filter on cardiopulmonary exercise testing variables in healthy subjects. Eur J Appl Physiol 2024; 124:1027-1036. [PMID: 37803179 DOI: 10.1007/s00421-023-05327-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 09/20/2023] [Indexed: 10/08/2023]
Abstract
PURPOSE Pathogen transmission during cardio-pulmonary exercise testing (CPET) is caused by carrier aerosols generated during respiration. METHODS Ten healthy volunteers (age range: 34 ± 15; 4 females) were recruited to see if the physiological reactions to ramp-incremental CPET on a cycle ergometer were affected using an in-line filter placed between the mouthpiece and the flow sensor. The tests were in random order with or without an in-line bacterial/viral spirometer filter. The work rate aligned, time interpolated 10 s bin data were compared throughout the exercise period. RESULTS From rest to peak exercise, filter use increased only minute ventilation ([Formula: see text]E) (Δ[Formula: see text]E = 1.56 ± 0.70 L/min, P < 0.001) and tidal volume (VT) (ΔVT = 0.10 ± 0.11 L, P = 0.014). Over the entire test, the slope of the residuals for [Formula: see text]CO2 was positive (0.035 ± 0.041 (ΔL/L), P = 0.027). During a ramp-incremental CPET in healthy subjects, an in-line filter increased [Formula: see text]E and VT but not metabolic rate. CONCLUSION In conclusion, using an in-line filter is feasible, does not affect appreciably the physiological variables, and may mitigate risk of aerosol dispersion during CPET.
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Affiliation(s)
- Asghar Abbasi
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W Carson St, CDCRC Building, Torrance, CA, 90502, USA.
| | - Khadije Ahmad
- Division of Cardiology, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Carrie Ferguson
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W Carson St, CDCRC Building, Torrance, CA, 90502, USA
| | - April Soriano
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W Carson St, CDCRC Building, Torrance, CA, 90502, USA
| | - Robert Calmelat
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W Carson St, CDCRC Building, Torrance, CA, 90502, USA
| | - Harry B Rossiter
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W Carson St, CDCRC Building, Torrance, CA, 90502, USA
| | - Richard Casaburi
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W Carson St, CDCRC Building, Torrance, CA, 90502, USA
| | - William W Stringer
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W Carson St, CDCRC Building, Torrance, CA, 90502, USA
| | - Janos Porszasz
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W Carson St, CDCRC Building, Torrance, CA, 90502, USA
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17
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Yang J, Andersen KM, Rai KK, Tritton T, Mugwagwa T, Tsang C, Reimbaeva M, McGrath LJ, Payne P, Backhouse B, Mendes D, Butfield R, Wood R, Nguyen JL. Health Care Resource Utilization and Costs Associated With COVID-19 Among Pediatrics Managed in the Community or Hospital Setting in England: A Population-based Cohort Study. Pediatr Infect Dis J 2024; 43:209-216. [PMID: 38113517 DOI: 10.1097/inf.0000000000004213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Although COVID-19 morbidity is significantly lower in pediatrics than in adults, the risk of severe COVID-19 may still pose substantial health care resource burden. This study aimed to describe health care resource utilization (HCRU) and costs associated with COVID-19 in pediatrics 1-17 years old in England. METHODS A population-based retrospective cohort study of pediatrics with COVID-19 using Clinical Practice Research Datalink (CPRD Aurum) primary care data and, where available, linked Hospital Episode Statistics Admitted Patient Care secondary care data. HCRU and associated costs to the National Health Service were stratified by age, risk of severe COVID-19 and immunocompromised status, separately for those with and without hospitalization records (hospitalized cohort: COVID-19 diagnosis August 2020-March 2021; primary care cohort: COVID-19 diagnosis August 2020-January 2022). RESULTS This study included 564,644 patients in the primary care cohort and 60 in the hospitalized cohort. Primary care consultations were more common in those 1-4 years of age (face-to-face: 4.3%; telephone: 6.0%) compared with those 5-11 (2.0%; 2.1%) and 12-17 years of age (2.2%; 2.5%). In the hospitalized cohort, mean (SD) length of stay was longer [5.0 (5.8) days] among those 12-17 years old (n = 24) than those 1-4 [n = 15; 1.8 (0.9) days] and 5-11 years old [n = 21; 2.8 (2.1) days]. CONCLUSIONS Most pediatrics diagnosed with COVID-19 were managed in the community. However, hospitalizations were an important driver of HCRU and costs, particularly for those 12-17 years old. Our results may help optimize the management and resource allocation of COVID-19 in this population.
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Affiliation(s)
- Jingyan Yang
- From the Pfizer Inc, New York City, New York
- Institute for Social and Economic Research and Policy, Columbia University, New York City, New York
| | | | - Kiran K Rai
- Adelphi Real World, Bollington, United Kingdom
| | | | | | | | | | | | - Poppy Payne
- Adelphi Real World, Bollington, United Kingdom
| | | | | | | | - Robert Wood
- Adelphi Real World, Bollington, United Kingdom
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18
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Khan R, Ji W, Guzman-Rivera J, Madhvi A, Andrews T, Richlin B, Suarez C, Gaur S, Cuddy W, Singh AR, Bukulmez H, Kaelber D, Kimura Y, Ganapathi U, Michailidis IE, Ukey R, Moroso-Fela S, Kuster JK, Casseus M, Roy J, Kleinman LC, Horton DB, Lakhani SA, Gennaro ML. A genetically modulated Toll-like-receptor-tolerant phenotype in peripheral blood cells of children with multisystem inflammatory syndrome. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.02.24301686. [PMID: 38370700 PMCID: PMC10871447 DOI: 10.1101/2024.02.02.24301686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Dysregulated innate immune responses contribute to multisystem inflammatory syndrome in children (MIS-C), characterized by gastrointestinal, mucocutaneous, and/or cardiovascular injury occurring weeks after SARS-CoV-2 exposure. To investigate innate immune functions in MIS-C, we stimulated ex vivo peripheral blood cells from MIS-C patients with agonists of Toll-like receptors (TLR), key innate immune response initiators. We found severely dampened cytokine responses and elevated gene expression of negative regulators of TLR signaling. Increased plasma levels of zonulin, a gut leakage marker, were also detected. These effects were also observed in children enrolled months after MIS-C recovery. Moreover, cells from MIS-C children carrying rare genetic variants of lysosomal trafficking regulator (LYST) were less refractory to TLR stimulation and exhibited lysosomal and mitochondrial abnormalities with altered energy metabolism. Our results strongly suggest that MIS-C hyperinflammation and/or excessive or prolonged stimulation with gut-originated TLR ligands drive immune cells to a lasting refractory state. TLR hyporesponsiveness is likely beneficial, as suggested by excess lymphopenia among rare LYST variant carriers. Our findings point to cellular mechanisms underlying TLR hyporesponsiveness; identify genetic determinants that may explain the MIS-C clinical spectrum; suggest potential associations between innate refractory states and long COVID; and highlight the need to monitor long-term consequences of MIS-C.
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Affiliation(s)
- Rehan Khan
- Public Health Research Institute, Rutgers New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ
| | - Weizhen Ji
- Pediatric Genomics Discovery Program, Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06510
| | - Jeisac Guzman-Rivera
- Public Health Research Institute, Rutgers New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ
| | - Abhilasha Madhvi
- Public Health Research Institute, Rutgers New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ
| | - Tracy Andrews
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Benjamin Richlin
- Pediatric Clinical Research Center, and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Christian Suarez
- Pediatric Clinical Research Center, and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Sunanda Gaur
- Department of Pediatrics, Clinical Research Center, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Aalok R Singh
- Maria Fareri Children's Hospital, Valhalla, NY
- New York Medical College, Valhalla, NY
| | - Hulya Bukulmez
- Department of Pediatrics, Division of Rheumatology, MetroHealth System, Cleveland OH
| | - David Kaelber
- Department of Pediatrics, Division of Rheumatology, MetroHealth System, Cleveland OH
- Center for Clinical Informatics Research and Education, MetroHealth System, Cleveland OH
- Department of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland OH
| | - Yukiko Kimura
- Hackensack University Medical Center, Hackensack Meridian School of Medicine, Nutley, NJ
| | - Usha Ganapathi
- Public Health Research Institute, Rutgers New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ
| | - Ioannis E Michailidis
- Public Health Research Institute, Rutgers New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ
| | - Rahul Ukey
- Public Health Research Institute, Rutgers New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ
| | - Sandra Moroso-Fela
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - John K Kuster
- Pediatric Genomics Discovery Program, Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06510
| | - Myriam Casseus
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jason Roy
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Lawrence C Kleinman
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Department of Global Urban Health, Rutgers School of Public Health, Piscataway, NJ
| | - Daniel B Horton
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ
| | - Saquib A Lakhani
- Pediatric Genomics Discovery Program, Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06510
| | - Maria Laura Gennaro
- Public Health Research Institute, Rutgers New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ
- Department of Medicine, Rutgers New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ
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19
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Liu P, Xing Z, Peng X, Zhang M, Shu C, Wang C, Li R, Tang L, Wei H, Ran X, Qiu S, Gao N, Yeo YH, Liu X, Ji F. Machine learning versus multivariate logistic regression for predicting severe COVID-19 in hospitalized children with Omicron variant infection. J Med Virol 2024; 96:e29447. [PMID: 38305064 DOI: 10.1002/jmv.29447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 01/02/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
With the emergence of the Omicron variant, the number of pediatric Coronavirus Disease 2019 (COVID-19) cases requiring hospitalization and developing severe or critical illness has significantly increased. Machine learning and multivariate logistic regression analysis were used to predict risk factors and develop prognostic models for severe COVID-19 in hospitalized children with the Omicron variant in this study. Of the 544 hospitalized children including 243 and 301 in the mild and severe groups, respectively. Fever (92.3%) was the most common symptom, followed by cough (79.4%), convulsions (36.8%), and vomiting (23.2%). The multivariate logistic regression analysis showed that age (1-3 years old, odds ratio (OR): 3.193, 95% confidence interval (CI): 1.778-5.733], comorbidity (OR: 1.993, 95% CI:1.154-3.443), cough (OR: 0.409, 95% CI:0.236-0.709), and baseline neutrophil-to-lymphocyte ratio (OR: 1.108, 95% CI: 1.023-1.200), lactate dehydrogenase (OR: 1.993, 95% CI: 1.154-3.443), blood urea nitrogen (OR: 1.002, 95% CI: 1.000-1.003) and total bilirubin (OR: 1.178, 95% CI: 1.005-3.381) were independent risk factors for severe COVID-19. The area under the curve (AUC) of the prediction models constructed by multivariate logistic regression analysis and machine learning (RandomForest + TomekLinks) were 0.7770 and 0.8590, respectively. The top 10 most important variables of random forest variables were selected to build a prediction model, with an AUC of 0.8210. Compared with multivariate logistic regression, machine learning models could more accurately predict severe COVID-19 in children with Omicron variant infection.
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Affiliation(s)
- Pan Liu
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, Xi'an, Shaanxi, China
| | - Zixuan Xing
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaokang Peng
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, Xi'an, Shaanxi, China
| | - Mengyi Zhang
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, China
| | - Chang Shu
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, Xi'an, Shaanxi, China
| | - Ce Wang
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, Xi'an, Shaanxi, China
| | - Ruina Li
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, Xi'an, Shaanxi, China
| | - Li Tang
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, Xi'an, Shaanxi, China
| | - Huijing Wei
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, Xi'an, Shaanxi, China
| | - Xiaoshan Ran
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, Xi'an, Shaanxi, China
| | - Sikai Qiu
- Department of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Ning Gao
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yee Hui Yeo
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Xiaoguai Liu
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, Xi'an, Shaanxi, China
| | - Fanpu Ji
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Shaanxi Provincial Clinical Medical Research Center of Infectious Diseases, Xi'an, China
- Key Laboratory of Surgical Critical Care and Life Support (Xi'an Jiaotong University), Ministry of Education, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, China
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20
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Jacobson JC, Ryan ML, Vogel AM, Mehl SC, Acker SN, Prendergast C, Padilla BE, Lee J, Chao SD, Martin NR, Russell KW, Larsen K, Harting MT, Linden AF, Ignacio RC, Slater BJ, Juang D, Jensen AR, Melhado CG, Pelayo JC, Zhong A, Spencer BL, Gadepalli SK, Maamari M, Jimenez Valencia M, Qureshi FG, Pandya SR. Outcomes of Extracorporeal Life Support Utilization for Pediatric Patients With COVID-19 Infections. ASAIO J 2024; 70:146-153. [PMID: 37816012 DOI: 10.1097/mat.0000000000002059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
Outcomes of pediatric patients who received extracorporeal life support (ECLS) for COVID-19 remain poorly described. The aim of this multi-institutional retrospective observational study was to evaluate these outcomes and assess for prognostic factors associated with in-hospital mortality. Seventy-nine patients at 14 pediatric centers across the United States who received ECLS support for COVID-19 infections between January 2020 and July 2022 were included for analysis. Data were extracted from the electronic medical record. The median age was 14.5 years (interquartile range [IQR]: 2-17 years). Most patients were female (54.4%) and had at least one pre-existing comorbidity (84.8%), such as obesity (44.3%, median body mass index percentile: 97% [IQR: 67.5-99.0%]). Venovenous (VV) ECLS was initiated in 50.6% of patients. Median duration of ECLS was 12 days (IQR: 6.0-22.5 days) with a mean duration from admission to ECLS initiation of 5.2 ± 6.3 days. Survival to hospital discharge was 54.4%. Neurological deficits were reported in 16.3% of survivors. Nonsurvivors were of older age (13.3 ± 6.2 years vs. 9.3 ± 7.7 years, p = 0.012), more likely to receive renal replacement therapy (63.9% vs. 30.2%, p = 0.003), demonstrated longer durations from admission to ECLS initiation (7.0 ± 8.1 days vs. 3.7 ± 3.8 days, p = 0.030), and had higher rates of ECLS-related complications (91.7% vs. 69.8%, p = 0.016) than survivors. Pediatric patients with COVID-19 who received ECLS demonstrated substantial morbidity and further investigation is warranted to optimize management strategies.
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Affiliation(s)
- Jillian C Jacobson
- From the Division of Pediatric Surgery, Children's Medical Center & Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mark L Ryan
- From the Division of Pediatric Surgery, Children's Medical Center & Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Adam M Vogel
- Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Steven C Mehl
- Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Shannon N Acker
- Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Connor Prendergast
- Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Benjamin E Padilla
- Department of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona
| | - Justin Lee
- Department of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona
| | - Stephanie D Chao
- Division of Pediatric Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Nolan R Martin
- Division of Pediatric Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Katie W Russell
- Department of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Kezlyn Larsen
- Department of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Matthew T Harting
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, Texas
| | - Allison F Linden
- Section of Pediatric Surgery, Department of Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Romeo C Ignacio
- Division of Pediatric Surgery/Department of Surgery, University of California School of Medicine, La Jolla, California
| | - Bethany J Slater
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - David Juang
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Aaron R Jensen
- Department of Pediatric Surgery, UCSF Benioff Children's Hospitals, Oakland, California
| | - Caroline G Melhado
- Department of Pediatric Surgery, UCSF Benioff Children's Hospitals, Oakland, California
| | - Juan Carlos Pelayo
- Division of Pediatric Surgery and Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Allen Zhong
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Brianna L Spencer
- Department of Surgery, University of Michigan, Michigan Medicine, Ann Arbor, Michigan
| | - Samir K Gadepalli
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Mott Children's Hospital, Ann Arbor, Michigan
- Department of Pediatric Surgery, Susan B. Meister Child Health Evaluation and Research Center, Michigan Medicine, Ann Arbor, Michigan
| | - Mia Maamari
- Division of Critical Care Medicine, UT Southwestern Medical Center, Children's Medical Center, Dallas, Texas
| | - Maria Jimenez Valencia
- From the Division of Pediatric Surgery, Children's Medical Center & Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Faisal G Qureshi
- From the Division of Pediatric Surgery, Children's Medical Center & Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Samir R Pandya
- From the Division of Pediatric Surgery, Children's Medical Center & Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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21
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Fumagalli I, Pagani S, Vergara C, Dede’ L, Adebo DA, Del Greco M, Frontera A, Luciani GB, Pontone G, Scrofani R, Quarteroni A. The role of computational methods in cardiovascular medicine: a narrative review. Transl Pediatr 2024; 13:146-163. [PMID: 38323181 PMCID: PMC10839285 DOI: 10.21037/tp-23-184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 12/13/2023] [Indexed: 02/08/2024] Open
Abstract
Background and Objective Computational models of the cardiovascular system allow for a detailed and quantitative investigation of both physiological and pathological conditions, thanks to their ability to combine clinical-possibly patient-specific-data with physical knowledge of the processes underlying the heart function. These models have been increasingly employed in clinical practice to understand pathological mechanisms and their progression, design medical devices, support clinicians in improving therapies. Hinging upon a long-year experience in cardiovascular modeling, we have recently constructed a computational multi-physics and multi-scale integrated model of the heart for the investigation of its physiological function, the analysis of pathological conditions, and to support clinicians in both diagnosis and treatment planning. This narrative review aims to systematically discuss the role that such model had in addressing specific clinical questions, and how further impact of computational models on clinical practice are envisaged. Methods We developed computational models of the physical processes encompassed by the heart function (electrophysiology, electrical activation, force generation, mechanics, blood flow dynamics, valve dynamics, myocardial perfusion) and of their inherently strong coupling. To solve the equations of such models, we devised advanced numerical methods, implemented in a flexible and highly efficient software library. We also developed computational procedures for clinical data post-processing-like the reconstruction of the heart geometry and motion from diagnostic images-and for their integration into computational models. Key Content and Findings Our integrated computational model of the heart function provides non-invasive measures of indicators characterizing the heart function and dysfunctions, and sheds light on its underlying processes and their coupling. Moreover, thanks to the close collaboration with several clinical partners, we addressed specific clinical questions on pathological conditions, such as arrhythmias, ventricular dyssynchrony, hypertrophic cardiomyopathy, degeneration of prosthetic valves, and the way coronavirus disease 2019 (COVID-19) infection may affect the cardiac function. In multiple cases, we were also able to provide quantitative indications for treatment. Conclusions Computational models provide a quantitative and detailed tool to support clinicians in patient care, which can enhance the assessment of cardiac diseases, the prediction of the development of pathological conditions, and the planning of treatments and follow-up tests.
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Affiliation(s)
- Ivan Fumagalli
- MOX Laboratory, Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Stefano Pagani
- MOX Laboratory, Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Christian Vergara
- Laboratory of Biological Structures Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
| | - Luca Dede’
- MOX Laboratory, Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Dilachew A. Adebo
- Children’s Heart Institute, Hermann Children’s Hospital, University of Texas Health Science Center, McGovern Medical School, Houston, TX, USA
| | - Maurizio Del Greco
- Department of Cardiology, S. Maria del Carmine Hospital, Rovereto, Italy
| | - Antonio Frontera
- Electrophysiology Department, De Gasperis Cardio Center, ASST Great Metropolitan Hospital Niguarda, Milan, Italy
| | | | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCSS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Roberto Scrofani
- Cardiovascular Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alfio Quarteroni
- MOX Laboratory, Department of Mathematics, Politecnico di Milano, Milan, Italy
- Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Switzerland
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22
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Benede N, Tincho MB, Walters A, Subbiah V, Ngomti A, Baguma R, Butters C, Hahnle L, Mennen M, Skelem S, Adriaanse M, Facey-Thomas H, Scott C, Day J, Spracklen TF, van Graan S, Balla SR, Moyo-Gwete T, Moore PL, MacGinty R, Botha M, Workman L, Johnson M, Goldblatt D, Zar HJ, Ntusi NA, Zühlke L, Webb K, Riou C, Burgers WA, Keeton RS. Distinct T cell polyfunctional profile in SARS-CoV-2 seronegative children associated with endemic human coronavirus cross-reactivity. iScience 2024; 27:108728. [PMID: 38235336 PMCID: PMC10792240 DOI: 10.1016/j.isci.2023.108728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/19/2023] [Accepted: 12/11/2023] [Indexed: 01/19/2024] Open
Abstract
SARS-CoV-2 infection in children typically results in asymptomatic or mild disease. There is a paucity of studies on SARS-CoV-2 antiviral immunity in African children. We investigated SARS-CoV-2-specific T cell responses in 71 unvaccinated asymptomatic South African children who were seropositive or seronegative for SARS-CoV-2. SARS-CoV-2-specific CD4+ T cell responses were detectable in 83% of seropositive and 60% of seronegative children. Although the magnitude of the CD4+ T cell response did not differ significantly between the two groups, their functional profiles were distinct, with SARS-CoV-2 seropositive children exhibiting a higher proportion of polyfunctional T cells compared to their seronegative counterparts. The frequency of SARS-CoV-2-specific CD4+ T cells in seronegative children was associated with the endemic human coronavirus (HCoV) HKU1 IgG response. Overall, the presence of SARS-CoV-2-responding T cells in seronegative children may result from cross-reactivity to endemic coronaviruses and could contribute to the relative protection from disease observed in SARS-CoV-2-infected children.
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Affiliation(s)
- Ntombi Benede
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | - Marius B. Tincho
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | - Avril Walters
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | - Vennesa Subbiah
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | - Amkele Ngomti
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | - Richard Baguma
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | - Claire Butters
- Division of Paediatric Rheumatology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Observatory, South Africa
| | - Lina Hahnle
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Observatory, South Africa
| | - Mathilda Mennen
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Observatory, South Africa
| | - Sango Skelem
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Observatory, South Africa
| | - Marguerite Adriaanse
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Observatory, South Africa
| | - Heidi Facey-Thomas
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Christiaan Scott
- Division of Paediatric Rheumatology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Observatory, South Africa
| | - Jonathan Day
- Division of Paediatric Rheumatology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Observatory, South Africa
| | - Timothy F. Spracklen
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
- South African Medical Research Council, Francie Van Zijl Drive, Parow Cape Town, South Africa
| | - Strauss van Graan
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Sashkia R. Balla
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Thandeka Moyo-Gwete
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Penny L. Moore
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | - Rae MacGinty
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Medical Research Council (MRC) Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Maresa Botha
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Medical Research Council (MRC) Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Lesley Workman
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Medical Research Council (MRC) Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Marina Johnson
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
| | - David Goldblatt
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
| | - Heather J. Zar
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Medical Research Council (MRC) Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, South Africa
| | - Ntobeko A.B. Ntusi
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Observatory, South Africa
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, South Africa
| | - Liesl Zühlke
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
- South African Medical Research Council, Francie Van Zijl Drive, Parow Cape Town, South Africa
| | - Kate Webb
- Division of Paediatric Rheumatology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Observatory, South Africa
- Crick African Network, The Francis Crick Institute, London, UK
| | - Catherine Riou
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, South Africa
| | - Wendy A. Burgers
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, South Africa
| | - Roanne S. Keeton
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa
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Aparicio C, Willis ZI, Nakamura MM, Wolf J, Little C, Maron GM, Sue PK, Anosike BI, Miller C, Bio LL, Singh P, James SH, Oliveira CR. Risk Factors for Pediatric Critical COVID-19: A Systematic Review and Meta-Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.17.24301452. [PMID: 38293040 PMCID: PMC10827273 DOI: 10.1101/2024.01.17.24301452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Background Risk stratification is a cornerstone of the Pediatric Infectious Diseases Society COVID-19 treatment guidance. This systematic review and meta-analysis aimed to define the clinical characteristics and comorbidities associated with critical COVID-19 in children and adolescents. Methods Two independent reviewers screened the literature (Medline and EMBASE) for studies published through August 2023 that reported outcome data on patients aged ≤21 years with COVID-19. Critical disease was defined as an invasive mechanical ventilation requirement, intensive care unit admission, or death. Random effects models were used to estimate pooled odds ratios (OR) with 95% confidence intervals (CI), and heterogeneity was explored through subgroup analyses. Results Among 10,178 articles, 136 studies met the inclusion criteria for review. Data from 70 studies, which collectively examined 172,165 children and adolescents with COVID-19, were pooled for meta-analysis. In previously healthy children, the absolute risk of critical disease from COVID-19 was 4% (95% CI, 1%-10%). Compared with no comorbidities, the pooled OR for critical disease was 3.95 (95% CI, 2.78-5.63) for presence of one comorbidity and 9.51 (95% CI, 5.62-16.06) for ≥2 comorbidities. Key risk factors included cardiovascular and neurological disorders, chronic pulmonary conditions (excluding asthma), diabetes, obesity, and immunocompromise, all with statistically significant ORs >2.00. Conclusions While the absolute risk for critical COVID-19 in children and adolescents without underlying health conditions is relatively low, the presence of one or more comorbidities was associated with markedly increased risk. These findings support the importance of risk stratification in tailoring pediatric COVID-19 management.
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Affiliation(s)
- Camila Aparicio
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Zachary I. Willis
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Mari M. Nakamura
- Antimicrobial Stewardship Program and Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA
| | - Joshua Wolf
- Department of Infectious Diseases, St. Jude Children’s Research Hospital and Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Cordell Little
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Gabriela M. Maron
- Department of Infectious Diseases, St. Jude Children’s Research Hospital and Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Paul K. Sue
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Brenda I. Anosike
- Department of Pediatrics, The Children’s Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, NY
| | - Christine Miller
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Laura L. Bio
- Department of Pharmacy, Lucile Packard Children’s Hospital, Stanford, CA
| | - Prachi Singh
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Scott H. James
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
| | - Carlos R. Oliveira
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
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24
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Flores-Cisneros L, Gutiérrez-Vargas R, Escondrillas-Maya C, Zaragoza-Jiménez C, Rodríguez GG, López-Gatell H, González- Islas D. Risk factors for severe disease and mortality in children with COVID-19. Heliyon 2024; 10:e23629. [PMID: 38192840 PMCID: PMC10772093 DOI: 10.1016/j.heliyon.2023.e23629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 08/29/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024] Open
Abstract
Background Pediatric COVID-19 patients have lower rates of hospitalization and fatal outcomes compared to adults with COVID-19; however, children represent a challenge in the detection, diagnosis, and treatment of COVID-19. Our aim was to determine the risk factors for hospital admission, invasive mechanical ventilation, and mortality in pediatric COVID-19 patients in Mexico during the COVID-19 pandemic. Material and methods A retrospective cohort of pediatric patients with COVID-19 from February 2020 to April 2021 was reported on the National Epidemiological Surveillance System for Viral Respiratory Disease (SISVER) platform. Results Among the 104,133 patients included in our study, 6214 were hospitalized, and 621 patients underwent invasive mechanical ventilation. A total of 0.65 % died during hospitalization. Children aged <12 months (odds ratio [OR]: 17.1; 95 % confidence interval [CI]: 15.9-19.4, p < 0.001), 1-4 years (OR: 3.69; 95 % CI: 3.2-4.1, p < 0.001), 5-9 years (OR: 1.86; 95 % CI: 1.66-2.08, p < 0.001), and 10-14 years (OR: 1.23; 95 % CI: 1.11-1.37, p < 0.001), and those diagnosed with diabetes (OR: 2.32; 95 % CI 1.68-3.20, p < 0.001) and obesity (OR: 1.24; 95 % CI 1.04-1.48, p = 0.015) were associated with hospital admission. Renal disease (OR: 3.85; 95 % CI: 2.25-6.59, p < 0.001) was associated with invasive mechanical ventilation. Pneumonia (OR: 15.9; 95 % CI: 12.6-20.1, p < 0.001) and renal disease (OR: 3.85; 95 % CI: 2.25-6.59, p value < 0.001) were associated with death. Conclusion Pneumonia increases the risk of death. The youngest age group has a higher risk of hospital admission. Comorbidities such as renal disease or immunosuppression increase the risk of death in all age groups.
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Affiliation(s)
| | | | | | | | | | - Hugo López-Gatell
- Subsecretaria de Prevención y Promoción de La Salud, Secretaría de Salud, Mexico City, Mexico
| | - Dulce González- Islas
- Departamento de Cardiología, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Calz. de Tlalpan 4502 Del. Tlalpan, Col. Seccion XVI, CP:14080 Mexico City, Mexico
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25
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Dias CS, Diniz LM, Oliveira MCL, Simões E Silva AC, Colosimo EA, Mak RH, Pinhati CC, Galante SC, Veloso IY, Martelli-Júnior H, Oliveira EA. Outcomes of SARS-CoV-2 and Seasonal Viruses Among Children Hospitalized in Brazil. Pediatrics 2024; 153:e2023064326. [PMID: 38213278 DOI: 10.1542/peds.2023-064326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Understanding how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) interacts with other respiratory viruses is crucial for developing effective public health strategies in the postpandemic era. This study aimed to compare the outcomes of SARS-CoV-2 and seasonal viruses in children and adolescents hospitalized with severe acute respiratory infection (SARI). METHODS This population-based, retrospective cohort study included children and adolescents hospitalized with SARI from February 2020 to February 2023 in Brazil. The main exposure of interest was viral etiology. The primary outcome was in-hospital mortality. Competing risk analysis was used to account for time dependency and competing events. RESULTS A total of 235 829 patients had available results of the viral tests, with SARS-CoV-2 predominance. According to the competing-risk survival analysis, the estimated probability of a fatal outcome at 30 days of hospitalization according to the viral strain was 6.5%, 3.4%, 2.9%, 2.3%, 2.1%, and 1.8%, for SARS-CoV-2, coinfection, adenovirus, influenza, other viruses, and respiratory syncytial virus, respectively. Individuals with a positive test for SARS-CoV-2 had hazard of death 3 times higher than subjects with a negative test (hazard ratio, 3.3; 95% confidence interval, 3.1-3.5). After adjustment by the competing-risk multivariable analysis, admission in Northeast and North regions, oxygen saturation <95%, and the presence of comorbidities were risk factors for death in all viral strains. CONCLUSIONS SARS-CoV-2 infection had the highest hazard of in-hospital mortality in this pediatric cohort hospitalized with SARI. Regardless of viral etiology, the presence of underlying medical conditions was a risk factor for death.
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Affiliation(s)
- Cristiane S Dias
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
| | - Lilian M Diniz
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
| | | | | | - Enrico A Colosimo
- Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Robert H Mak
- Department of Pediatrics, Rady Children's Hospital, University of California, San Diego
| | - Clara C Pinhati
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
| | - Stella C Galante
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
| | - Isadora Y Veloso
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
| | - Hercílio Martelli-Júnior
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros (Unimontes), Montes Claros, Minas Gerais, Brazil
| | - Eduardo A Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
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26
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Leavitt T, Brooks RL, Mitchell RB, Johnson RF, Chorney SR. Adolescent Tracheostomy for COVID-19 Respiratory Failure. EAR, NOSE & THROAT JOURNAL 2024; 103:NP22-NP24. [PMID: 34328811 DOI: 10.1177/01455613211034594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pediatric tracheostomy for COVID-19 infections is uncommon and requires age-appropriate adaptations. This case adds to a limited body of literature related to tracheostomy placement and management in an adolescent. Thoughtful planning and communication by a dedicated tracheostomy team was crucial in obtaining a successful outcome.
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Affiliation(s)
- Taylor Leavitt
- University of Texas Southwestern Medical Center, Department of Otolaryngology-Head and Neck Surgery, Dallas, TX, USA
| | - Rebecca L Brooks
- University of Texas Southwestern Medical Center, Department of Otolaryngology-Head and Neck Surgery, Dallas, TX, USA
- Children's Medical Center of Dallas, Department of Pediatric Otolaryngology, Dallas, TX, USA
| | - Ron B Mitchell
- University of Texas Southwestern Medical Center, Department of Otolaryngology-Head and Neck Surgery, Dallas, TX, USA
- Children's Medical Center of Dallas, Department of Pediatric Otolaryngology, Dallas, TX, USA
| | - Romaine F Johnson
- University of Texas Southwestern Medical Center, Department of Otolaryngology-Head and Neck Surgery, Dallas, TX, USA
- Children's Medical Center of Dallas, Department of Pediatric Otolaryngology, Dallas, TX, USA
| | - Stephen R Chorney
- University of Texas Southwestern Medical Center, Department of Otolaryngology-Head and Neck Surgery, Dallas, TX, USA
- Children's Medical Center of Dallas, Department of Pediatric Otolaryngology, Dallas, TX, USA
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27
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Alshehri SS, Minhaji BI, Pasha MR, Fouda D, Joseph J, Ahmed N. Characteristics and Outcomes of Children With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection Admitted to a Quaternary Hospital: A Single-Center Experience. Cureus 2024; 16:e52532. [PMID: 38371066 PMCID: PMC10870100 DOI: 10.7759/cureus.52532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Objectives In the setting of the recent global pandemic, children infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus causing the coronavirus disease 2019 (COVID-19) presented to our hospital with a variety of symptoms ranging from mild to severe disease including multiorgan dysfunction. Our objective was to study the clinical profile, risk factors, complications, and outcomes in pediatric patients admitted to our center with SARS-CoV-2 infection. Methods This retrospective observational study was conducted at a large quaternary center in Riyadh between May 2020 and September 2021. The study population was comprised of children between 0 and ≤14 years with SARS-CoV-2 suspicion or positivity. Results One hundred and fifty-six children were included in the study, the majority of whom were 1-10 years old. One hundred and twenty of them (76.93%) were SARS-CoV-2 positive. Fifty-nine patients (37.18%) were labelled as multisystem inflammatory syndrome in children (MIS-C) based on clinical and lab criteria, of whom 35 (22.44%) tested SARS-CoV-2 positive. Hematological disease was found to be the most common comorbidity, followed by neurological and chronic lung diseases. The most common symptoms encountered were fever, cough, vomiting, fatigue, and diarrhea. Eighty patients (51%) required pediatric intensive care unit (PICU) admission (length of stay: 5-12 days), among whom 32 (40%) required ventilation, 26 (32.5%) needed hemodynamic support, and three patients (3.75%) underwent continuous renal replacement therapy (CRRT). The overall mortality rate was 4.5% (seven patients) among the studied population. The most frequent lab abnormalities were found to be elevated serum ferritin, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and lactate dehydrogenase (LDH) levels. Ninety-one percent received antibiotics, and prophylactic anticoagulant was used in 32%. In the MIS-C subset, 80.5% received steroids, 71.43% intravenous immunoglobulin (IVIG), and 5.17% (three patients) tocilizumab. Conclusion The SARS-CoV-2 infection presented with a range of severity among our cohort of children; however, most of the patients responded well to appropriate supportive treatment. A slight male preponderance was noted. The most common symptoms encountered were fever, cough, vomiting, fatigue, and diarrhea. Inflammatory markers such as ESR, CRP, serum ferritin, and LDH levels were found to be elevated in nearly all patients. Raised serum lactate and serum creatinine and lymphopenia were of significant note in patients with MIS-C. Higher mortality rates were observed in patients with MIS-C and those requiring respiratory support. In addition to these two factors, the presence of comorbidities and the need for CRRT were associated with prolonged PICU length of stay.
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Affiliation(s)
- Saleh S Alshehri
- Pediatric Intensive Care Unit, King Saud Medical City, Riyadh, SAU
| | - Bushra I Minhaji
- Pediatric Intensive Care Unit, King Saud Medical City, Riyadh, SAU
| | - Mohsina R Pasha
- Pediatric Intensive Care Unit, King Saud Medical City, Riyadh, SAU
| | - Dina Fouda
- Pharmaceutical Care Services, King Saud Medical City, Riyadh, SAU
| | - Jency Joseph
- Nursing Administration, King Saud Medical City, Riyadh, SAU
| | - Nehad Ahmed
- Clinical Pharmacy, Prince Sattam bin Abdulaziz University, Alkharj, SAU
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Akkoyun EB, Ashraf B, Hanners N, Kahn J, Most Z. Gastrointestinal Manifestations Are Associated with Severe COVID-19 in Children. Healthcare (Basel) 2023; 12:81. [PMID: 38200987 PMCID: PMC10778896 DOI: 10.3390/healthcare12010081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
Purpose: Although less severe than in adults, children can experience a range of COVID-19 symptoms, from asymptomatic to life-threatening, including respiratory and gastrointestinal symptoms. Medical conditions may also increase the severity of the disease in infected children. Methods: This study was performed at a single center, comparing cases and controls, and involving 253 pediatric patients who had been diagnosed with COVID-19. Two different outcomes were assessed. The first categorized symptomatic individuals who were hospitalized with COVID-19 (hospital) from those who were not (nonhospital). The second categorized admitted individuals who spent at least one day in the intensive care unit (ICU) from those who did not require intensive care (floor). Results: Ninety individuals (36%) had at least one underlying medical condition, the most common being pulmonary disorders, such as asthma (12%), followed by neurodevelopmental disorders (8%), gastrointestinal disorders (6%), and seizure disorders (6%). The hospital group was more likely to have a comorbidity, such as obstructive sleep apnea (OSA), diabetes mellitus, seizure disorder, hypertension, sickle cell disease, neurodevelopmental disorder, and immunocompromising conditions, including cancer, bone marrow transplant, and other immunodeficiencies, compared to the non-hospital group. Abdominal pain was more common in the hospital group. Shortness of breath (SOB) and diarrhea were significantly more common in the ICU group than in the floor group. Conclusions: Early identification of pediatric patients with severe COVID-19 is important to improve outcomes. In our single-center case-control study, we found that the presence of gastrointestinal symptoms on presentation was more commonly associated with severe COVID-19 in children.
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Affiliation(s)
- Esra Betul Akkoyun
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (N.H.); (J.K.); (Z.M.)
| | - Bilal Ashraf
- Department of Internal Medicine/Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Natasha Hanners
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (N.H.); (J.K.); (Z.M.)
| | - Jeffrey Kahn
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (N.H.); (J.K.); (Z.M.)
| | - Zachary Most
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (N.H.); (J.K.); (Z.M.)
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Boruah AP, Thakur KT, Gadani SP, Kothari KU, Chomba M, Guekht A, Heydari K, Hoo FK, Hwang S, Michael BD, Pandit MV, Pardo CA, Prasad K, Sardar Z, Seeher K, Solomon T, Winkler AS, Wood GK, Schiess N. Pre-existing neurological conditions and COVID-19 co-infection: Data from systematic reviews, meta-analyses, and scoping reviews. J Neurol Sci 2023; 455:120858. [PMID: 37948972 PMCID: PMC10751535 DOI: 10.1016/j.jns.2023.120858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Pre-existing neurological diseases have been identified as risk factors for severe COVID-19 infection and death. There is a lack of comprehensive literature review assessing the relationship between pre-existing neurological conditions and COVID-19 outcomes. Identification of high risk groups is critical for optimal treatment and care. METHODS A literature review was conducted for systematic reviews, meta-analyses, and scoping reviews published between January 1, 2020 and January 1, 2023. Literature assessing individuals with pre-existing neurological diseases and COVID-19 infection was included. Information regarding infection severity was extracted, and potential limitations were identified. RESULTS Thirty-nine articles met inclusion criteria, with data assessing >3 million patients from 51 countries. 26/51 (50.9%) of countries analyzed were classified as high income, while the remaining represented middle-low income countries (25/51; 49.0%). A majority of evidence focused on the impact of cerebrovascular disease (17/39; 43.5%) and dementia (5/39; 12.8%) on COVID-19 severity and mortality. 92.3% of the articles (36/39) suggested a significant association between neurological conditions and increased risk of severe COVID-19 and mortality. Cerebrovascular disease, dementia, Parkinson's disease, and epilepsy were associated with increased COVID severity and mortality. CONCLUSION Pre-existing neurological diseases including cerebrovascular disease, Alzheimer's disease and other dementias, epilepsy, and Parkinson's disease are significant risk factors for severity of COVID-19 infection and mortality in the acute infectious period. Given that 61.5% (24/39) of the current evidence only includes data from 2020, further updated literature is crucial to identify the relationship between chronic neurological conditions and clinical characteristics of COVID-19 variants.
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Affiliation(s)
| | - Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, USA
| | | | - Kavita U Kothari
- Consultant to Library & Digital Information Networks, World Health Organization, Geneva, Switzerland
| | | | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia; Pirogov Russian Medical Research University, Moscow, Russia
| | | | - Fan Kee Hoo
- Faculty of Medicine and Health Sciences, University Putra Malaysia, Kuala Lumpur, Malaysia
| | | | - Benedict D Michael
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Department of Neurology, Walton Centre NHS Foundation Trust, NIHR Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, UK
| | | | | | - Kameshwar Prasad
- Department of Neurology Fortis Flt Lt, Rajan Dhall Hospital, Vasant Kunj, New Delhi, India
| | - Zomer Sardar
- Columbia University Irving Medical Center, New York, NY, USA
| | - Katrin Seeher
- Brain Health Unit, World Health Organization, Geneva, Switzerland
| | - Tom Solomon
- The Pandemic Institute, The Spine, Liverpool L7 3FA, UK; National Institute for Health and Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool L69 7BE, UK; Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool L69 7BE, UK; Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - Andrea S Winkler
- Department of Neurology, Center for Global Health, Technical University of Munich, Munich, Germany; Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Greta K Wood
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK
| | - Nicoline Schiess
- Brain Health Unit, World Health Organization, Geneva, Switzerland.
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Seah VXF, Ong RYL, Kam KQ, Thoon KC, Tan NWH, Li J, Nadua KD, Chong CY, Yung CF. Remdesivir therapy for severe pediatric COVID-19 in Singapore: A single-center retrospective observational cohort study. Health Sci Rep 2023; 6:e1698. [PMID: 38098972 PMCID: PMC10719654 DOI: 10.1002/hsr2.1698] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/14/2023] [Accepted: 10/30/2023] [Indexed: 12/17/2023] Open
Abstract
Background and Aims There is a paucity of information on remdesivir (RDV) use in severe pediatric coronavirus disease 2019 (COVID-19). We aimed to explore the effectiveness of RDV as the cumulative proportion of pediatric COVID-19 patients deescalated from Day 5 of high dependency or intensive care unit (HD/ICU). Methods All children ≤18 years admitted to Singapore's largest pediatric hospital from January 1, 2020 to March 18, 2022 were reviewed retrospectively. Patients were included if they were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on reverse transcriptase polymerase chain reaction, required oxygen, and HD/ICU care. The characteristics and outcomes of those who received RDV or not (no-RDV) were compared. Results We reviewed 15 children with a median age of 2.5 years (interquartile range [IQR]: 0.8-11.0), of which 7 (46.7%) received RDV. There was no difference in cumulative proportion of children deescalated from Day 5 of HD/ICU care in the RDV versus the no-RDV group (5/7, 70% vs. 7/8, 87.5%, p = 0.57). The RDV versus no-RDV group had higher disease severity, that is, WHO Ordinal Scale scores (median 6, IQR: 5-7 vs. 5, IQR: 4-5, p = 0.03), higher procalcitonin levels (ug/L) (median 4.31, IQR: 0.8-24.2 vs. 0.12, IQR: 0.09-0.26, p = 0.02), and longer HD/ICU care days (median 5, IQR: 4-9, vs. 1, IQR: 1-4, p = 0.01). There was no significant difference in hospitalization days. There were no adverse events directly attributable to RDV. None died from COVID-19 infection. Conclusion Our observational analysis was unable to detect any clear benefit of RDV in terms of reducing duration in HD/ICU. RDV was well-tolerated in children with severe COVID-19.
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Affiliation(s)
| | - Rina Yue Ling Ong
- Department of PharmacyKK Women's and Children's HospitalSingaporeSingapore
| | - Kai Qian Kam
- Infectious Disease Service, Department of PaediatricsKK Women's and Children's HospitalSingaporeSingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Koh Cheng Thoon
- Infectious Disease Service, Department of PaediatricsKK Women's and Children's HospitalSingaporeSingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Natalie Woon Hui Tan
- Infectious Disease Service, Department of PaediatricsKK Women's and Children's HospitalSingaporeSingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Jiahui Li
- Infectious Disease Service, Department of PaediatricsKK Women's and Children's HospitalSingaporeSingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Karen Donceras Nadua
- Infectious Disease Service, Department of PaediatricsKK Women's and Children's HospitalSingaporeSingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Chia Yin Chong
- Infectious Disease Service, Department of PaediatricsKK Women's and Children's HospitalSingaporeSingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Chee Fu Yung
- Infectious Disease Service, Department of PaediatricsKK Women's and Children's HospitalSingaporeSingapore
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
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Wu JY, Liu MY, Liu TH, Chuang MH, Hsu WH, Huang PY, Tsai YW, Lai CC. Association between nirmatrelvir plus ritonavir and the outcomes of non-hospitalized obese patients with COVID-19. Int J Antimicrob Agents 2023; 62:106984. [PMID: 37769748 DOI: 10.1016/j.ijantimicag.2023.106984] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 08/26/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To investigate the association between nirmatrelvir plus ritonavir (NMV-r) and the outcomes of non-hospitalized obese patients with coronavirus disease 2019 (COVID-19). METHODS This retrospective cohort study used the TriNetX research network to identify non-hospitalized obese adult patients with COVID-19 between 1 January 2022 and 30 June 2023. Propensity score matching was used to match patients receiving NMV-r (NMV-r group) with those not receiving NMV-r (control group). The primary outcome was the compositive outcome of all-cause emergency department (ED) visits, hospitalization or death during the 30-day follow-up period. RESULTS Using propensity score matching methods, two cohorts of 30,969 patients each with balanced baseline characteristics were identified. During the follow-up period, the NMV-r group had a lower risk of all-cause ED visits, hospitalization or death [4.80% (n=1489) vs 5.50% (n=1705); hazard ratio (HR) 0.900, 95% confidence interval (CI) 0.839-0.965]. Compared with the control group, the NMV-r group had a lower risk of all-cause ED visits (HR 0.812, 95% CI 0.740-0.891) and all-cause mortality (HR 0.089, 95% CI 0.027-0.288). The lower risk in the NMV-r group compared with the control group was observed consistently in most subgroup analyses according to body mass index (30.0-34.9 kg/m2: HR 0.68, 95% CI 0.55-0.82; 35.0-39.9 kg/m2: HR 0.67, 95% CI 0.52-0.87), age (4-64 years: HR 0.83, 95% CI 0.75-0.92; ≥65 years: HR 0.88, 95% CI 0.79-0.98), sex (men: HR 0.69, 95% CI 0.60-0.79; women: HR 0.69, 95% CI 0.63-0.76) and vaccination status (unvaccinated: HR 0.75, 95% CI 0.70-0.81). CONCLUSION NMV-r is associated with reduced risk of all-cause ED visits, hospitalization and death for non-hospitalized obese patients with COVID-19. Accordingly, these findings support the use of NMV-r in obese patients.
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Affiliation(s)
- Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Centre, Tainan, Taiwan
| | - Mei-Yuan Liu
- Department of Nutrition, Chi Mei Medical Centre, Tainan, Taiwan; Department of Nutrition and Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Ting-Hui Liu
- Department of Psychiatry, Chi Mei Medical Centre, Tainan, Taiwan
| | - Min-Hsiang Chuang
- Department of Internal Medicine, Chi Mei Medical Centre, Tainan, Taiwan
| | - Wan-Hsuan Hsu
- Department of Psychiatry, Chi Mei Medical Centre, Tainan, Taiwan
| | - Po-Yu Huang
- Department of Internal Medicine, Chi Mei Medical Centre, Tainan, Taiwan
| | - Ya-Wen Tsai
- Centre of Integrative Medicine, Chi Mei Medical Centre, Tainan, Taiwan
| | - Chih-Cheng Lai
- Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Centre, Tainan, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.
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Syzdoł B, Rzewuska AM, Sielwanowska W, Żybowska M, Wilczek NA, Woźniak MM. Ischemic Stroke in the Course of COVID-19 in a 16-Year-Old Boy. J Clin Med 2023; 12:6963. [PMID: 38002578 PMCID: PMC10672380 DOI: 10.3390/jcm12226963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/28/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
The SARS-CoV-2 virus that causes COVID-19 disease is still evolving and, despite the end of the acute phase of the pandemic, still poses a risk to public health. One of the very rare complications, occurring in less than 1% of children, is multisystem inflammatory syndrome in children (MISC). Due to the risk of thromboembolic complications as well as cardiac problems, MISC carries a number of life-threatening complications. We report a case of a 16-year-old boy who was hospitalized due to general weakness, fever, conjunctivitis, vomiting and diarrhoea. In view of the mother's positive result of the SARS-CoV-2 test, the teenager underwent numerous laboratory tests. Taking into account the critical condition of the patient, anticoagulant and antipyretic treatment, steroids and IVIG were added. During hospitalisation, alarming symptoms occurred, including dysarthria, drooping corner of the mouth and muscle weakness on the right side. The magnetic resonance imaging showed changes characteristic of ischemic stroke. Further studies are needed to assess possible thrombotic complications in children after SARS-CoV-2 infection, and specialists should be more vigilant in paediatric patients presenting with such symptoms.
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Affiliation(s)
- Bartłomiej Syzdoł
- Students’ Scientific Society at the Department of Pediatric Radiology, Medical University of Lublin, 20-059 Lublin, Poland; (B.S.); (A.M.R.); (W.S.); (M.Ż.)
| | - Anna Maria Rzewuska
- Students’ Scientific Society at the Department of Pediatric Radiology, Medical University of Lublin, 20-059 Lublin, Poland; (B.S.); (A.M.R.); (W.S.); (M.Ż.)
| | - Wiktoria Sielwanowska
- Students’ Scientific Society at the Department of Pediatric Radiology, Medical University of Lublin, 20-059 Lublin, Poland; (B.S.); (A.M.R.); (W.S.); (M.Ż.)
| | - Monika Żybowska
- Students’ Scientific Society at the Department of Pediatric Radiology, Medical University of Lublin, 20-059 Lublin, Poland; (B.S.); (A.M.R.); (W.S.); (M.Ż.)
| | - Natalia Anna Wilczek
- Students’ Research Group at the Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, 20-059 Lublin, Poland;
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de Mello LB, da Silva JA, Clemente HA, Neto JAB, Mello CS. Nutritional risk and clinical outcomes of COVID-19 in hospitalized children and adolescents: a multicenter cohort. J Pediatr (Rio J) 2023; 99:641-647. [PMID: 37478896 PMCID: PMC10594002 DOI: 10.1016/j.jped.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 07/23/2023] Open
Abstract
OBJECTIVE To verify the association between nutritional risk on admission and clinical outcomes of COVID-19 in hospitalized children and adolescents. METHODS Multicenter cohort study was conducted in two cities in the northeastern region of Brazil, with children under 18 years of age laboratory diagnosed with COVID-19. Sociodemographic data and nutritional risk screening by STRONGKids (low, medium and high risk) were collected remotely and in hospital records, respectively. The outcomes assessed were the need for ICU admission, length of stay (< 10 days or ≥ 10 days), critical cases, and death. Multivariable logistic regression models were used to evaluate the effects of high nutritional risk on COVID-19 clinical outcomes. RESULTS 103 individuals were evaluated, of these 35 (34.0%) had low risk, 44 (42.7%) medium risk, and 24 (23.3%) had high risk of malnutrition. In multivariate analysis, ICU bed admission (OR: 4.57; 95%CI, 1.39-4.97; p = 0.01), hospitalization longer than or equal to ten days (OR: 3.96; 95%CI, 1.22-2.83; p = 0.02) and critical cases (OR: 4.35; 95%CI, 1.08-7.55; p = 0.04) were associated with high nutritional risk. Death was not associated with high nutritional risk. CONCLUSIONS Children and adolescents with high nutritional risk by STRONGkids at hospital admission were more likely to be admitted to the ICU, have hospitalization longer than or equal to ten days, and have critical cases when infected with SARS-CoV-2.
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Affiliation(s)
- Leilah B de Mello
- Universidade Federal da Bahia (UFBA), Escola de Nutrição, Nutrição Clínica, Salvador, BA, Brazil
| | - José Adailton da Silva
- Universidade Federal do Rio Grande do Norte (UFRN), Faculdade de Ciências da Saúde do Trairi, Saúde Coletiva, Natal, RN, Brazil
| | - Heleni A Clemente
- Universidade Federal do Rio Grande do Norte (UFRN), Faculdade de Ciências da Saúde do Trairi, Saúde Coletiva, Natal, RN, Brazil
| | - João A Barros Neto
- Universidade Federal de Alagoas (UFAL), Faculdade de Nutrição, Processos Interativos dos Órgãos e Sistemas, Maceió, AL, Brazil
| | - Carolina S Mello
- Universidade Federal da Bahia (UFBA), Escola de Nutrição, Pediatria e Ciências Aplicadas à Pediatria, Salvador, BA, Brazil.
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Fardell JE, Hu N, Wakefield CE, Marshall G, Bell J, Lingam R, Nassar N. Impact of Hospitalizations due to Chronic Health Conditions on Early Child Development. J Pediatr Psychol 2023; 48:799-811. [PMID: 37105227 DOI: 10.1093/jpepsy/jsad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE To assess the impact of hospitalization for chronic health conditions on early child development and wellbeing at school start. METHODS We conducted a longitudinal cohort study of children starting school using population-based record linkage of routinely collected admitted hospital data and standardized assessment of early childhood development (Australian Early Developmental Census: AEDC). Developmental vulnerability (DV) was defined as children scoring <10th centile in any one of five developmental domains. Children scoring <10th centile on two or more domains were considered developmentally high-risk (DHR). Children hospitalized with chronic health conditions were compared to children without hospitalizations prior to school start. RESULTS Among 152,851 children with an AEDC record, 22,271 (14·6%) were hospitalized with a chronic condition. Children hospitalized with chronic health conditions were more likely to be DHR (adjusted odds ratio 1.25, 95% CI: 1.18-1.31) compared to children without hospitalizations. Children hospitalized more frequently (>7 times) or with longer duration (>2 weeks) had a 40% increased risk of being DHR (1.40, 95% CI: 1.05-1.88 and 1.40, 95% CI: 1.13-1.74, respectively). Children hospitalized with mental health/behavioral/developmental conditions had the highest risk of DHR (2.23, 95% CI: 1.72-2.90). Developmental vulnerability was increased for physical health (1.37, 95% CI: 1.30-1.45), language (1.28, 95% CI: 1.19-1.38), social competence (1.22, 95% CI: 1.16-1.29), communication (1.17, 95% CI: 1.10-1.23), and emotional maturity (1.16, 95% CI: 1.09-1.23). CONCLUSIONS Frequent and longer duration hospitalizations for chronic health conditions can impact early childhood development. Research and interventions are required to support future development and well-being of children with chronic health conditions who are hospitalized.
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Affiliation(s)
- Joanna E Fardell
- Behavioural Sciences Unit, School of Women's and Children's Health, UNSW Sydney, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Australia
| | - Nan Hu
- Population Child Health Research Group, School of Women's and Children's Health, University of New South Wales, Australia
| | - Claire E Wakefield
- Behavioural Sciences Unit, School of Women's and Children's Health, UNSW Sydney, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Australia
| | - Glenn Marshall
- Kids Cancer Centre, Sydney Children's Hospital, Australia
| | - Jane Bell
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, University of Sydney, Australia
| | - Raghu Lingam
- Population Child Health Research Group, School of Women's and Children's Health, University of New South Wales, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, University of Sydney, Australia
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da Silva ACCAC, Luiz RR, de Moraes JR, Rocha PHV, Zeitoune RCG, Barbosa AP, Moreira JPDL. Hospital mortality from covid-19 in children and adolescents in Brazil in 2020-2021. Rev Saude Publica 2023; 57:56. [PMID: 37878842 PMCID: PMC10519682 DOI: 10.11606/s1518-8787.2023057005172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE To describe cases, deaths, and hospital mortality from covid-19 in children and adolescents in Brazil, according to age group, during the evolving phases of the pandemic in 2020 and 2021. METHODS Census of patients aged up to 19 committed with severe acute respiratory syndrome, due to covid-19 or unspecified, notified to the Brazilian Influenza Epidemiological Surveillance Information System, from January 1, 2020, to December 31, 2021. The two years were divided into six phases, covering the spread of the disease-first, second and third wave-as well as the impact of vaccination. The pediatric population was categorized into infants, preschoolers, schoolchildren, and adolescents. Hospital mortality was assessed by pandemic phase and age group. RESULTS A total of 144,041 patients were recorded in the two years, 18.2% of whom had confirmed cases of covid-19. Children under 5 years old (infants and preschoolers) accounted for 62.8% of those hospitalized. A total of 4,471 patients died, representing about 6.1 deaths per day. Infants were the ones who most progressed to the intensive care unit (24.7%) and had the highest gross number of deaths (n = 2,012), but mortality was higher among adolescents (5.7%), reaching 9.8% in phase 1. The first peak of deaths occurred in phase 1 (May/2020), and two other peaks occurred in phase 4 (March/2021 and May/2021). There was an increase in cases and deaths for younger ages since phase 4. Hospital mortality in the pediatric population was higher in phases 1, 4, and 6, following the phenomena of dissemination/interiorization of the virus in the country, beginning of the second wave and beginning of the third wave, respectively. CONCLUSION The absolute number of cases of covid-19 in children and adolescents is significant. Although complete vaccination in descending order of age provided a natural deviation in age range, there was a greater gap between the curve of new hospitalized cases and the curve of deaths, indicating the positive impact of immunization.
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Affiliation(s)
- Amanda Cilene Cruz Aguiar Castilho da Silva
- Universidade Federal do Rio de JaneiroEscola de Enfermagem Anna NeryRio de JaneiroRJBrazilUniversidade Federal do Rio de Janeiro. Escola de Enfermagem Anna Nery. Rio de Janeiro, RJ, Brazil.
| | - Ronir Raggio Luiz
- Universidade Federal do Rio de JaneiroInstituto de Saúde ColetivaRio de JaneiroRJBrazilUniversidade Federal do Rio de Janeiro. Instituto de Saúde Coletiva. Rio de Janeiro, RJ, Brazil.
| | - José Rodrigo de Moraes
- Universidade Federal FluminenseInstituto de Matemática e EstatísticaDepartamento de EstatísticaNiteróiRJBrazilUniversidade Federal Fluminense. Instituto de Matemática e Estatística. Departamento de Estatística. Niterói, RJ, Brazil.
| | - Pedro Henrique Vieira Rocha
- Universidade Federal FluminenseFaculdade de FarmáciaNiteróiRJBrazilUniversidade Federal Fluminense. Faculdade de Farmácia. Niterói, RJ, Brazil.
| | - Regina Célia Gollner Zeitoune
- Universidade Federal do Rio de JaneiroEscola de Enfermagem Anna NeryRio de JaneiroRJBrazilUniversidade Federal do Rio de Janeiro. Escola de Enfermagem Anna Nery. Rio de Janeiro, RJ, Brazil.
| | - Arnaldo Prata Barbosa
- Instituto D’Or de Pesquisa e EnsinoDepartamento de PediatriaRio de JaneiroRJBrazilInstituto D’Or de Pesquisa e Ensino. Departamento de Pediatria. Rio de Janeiro, RJ, Brazil.
| | - Jessica Pronestino de Lima Moreira
- Universidade Federal FluminenseFaculdade de FarmáciaDepartamento de BromatologiaNiteróiRJBrazilUniversidade Federal Fluminense. Faculdade de Farmácia. Departamento de Bromatologia. Niterói, RJ, Brazil.
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Rosazza C, Alagna L, Bandera A, Biffi A, Ciciriello F, Gramegna A, Lucidi V, Marchisio PG, Medino P, Muscatiello A, Uceda Renteria S, Colombo C. Severity of SARS-CoV-2 infection in a hospital population: a clinical comparison across age groups. Ital J Pediatr 2023; 49:135. [PMID: 37807040 PMCID: PMC10561461 DOI: 10.1186/s13052-023-01485-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/22/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Children tend to have milder forms of COVID-19 than adults, however post-acute complications have been observed also in the paediatric population. In this study, we compared COVID-19-related outcomes and long-term complications between paediatric and adult patients infected by SARS-CoV-2. METHODS The study is based on individuals enrolled from October 2020 to June 2021 in the DECO COVID-19 multicentre prospective study supported by the Italian Ministry of Health (COVID-2020-12371781). We included individuals with RT-PCR -confirmed SARS-CoV-2 infection, who were evaluated in the emergency department and/or admitted to COVID-dedicated wards. The severity of SARS-CoV-2 infection was compared across age groups (children/adolescents aged < 18 years, young/middle-aged adults aged 18-64 years and older individuals) through the relative risk (RR) of severe COVID-19. Severity was defined by: 1) hospitalization due to COVID-19 and/or 2) need or supplemental oxygen therapy. RR and corresponding 95% confidence intervals were estimated using log-binomial models. RESULTS The study included 154 individuals, 84 (54.5%) children/adolescents, 50 (32.5%) young/middle-aged adults and 20 (13%) older adults. Compared to young/middle-aged adults the risk of hospitalization was lower among paediatric patients (RR: 0.49, 95% CI: 0.32-0.75) and higher among older adults (RR: 1.52, 95% CI: 1.12-2.06). The RR of supplemental oxygen was 0.12 (95% CI: 0.05-0.30) among children/adolescents and 1.46 (95% CI: 0.97-2.19) among older adults. Three children developed multisystem inflammatory syndrome (MIS-C), none was admitted to intensive care unit or reported post-acute Covid-19 complications. CONCLUSIONS Our study confirms that COVID-19 is less severe in children. MIS-C is a rare yet severe complication of SARS-CoV-2 infection in children and its risk factors are presently unknown.
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Affiliation(s)
- Chiara Rosazza
- Paediatric Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Alagna
- Clinic of Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Bandera
- Clinic of Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Via Commenda 9, 20122, Milan, Italy
| | - Arianna Biffi
- Paediatric Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabiana Ciciriello
- Cystic Fibrosis Center, 'Bambino Gesù' Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, University of Milan, Via Commenda 9, 20122, Milan, Italy
- Internal Medicine Department, Respiratory Unit and Regional Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vincenzina Lucidi
- Cystic Fibrosis Center, 'Bambino Gesù' Children's Hospital, IRCCS, Rome, Italy
| | - Paola Giovanna Marchisio
- Department of Pathophysiology and Transplantation, University of Milan, Via Commenda 9, 20122, Milan, Italy
- Pediatria Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Medino
- Paediatric Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Muscatiello
- Clinic of Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Uceda Renteria
- Virology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carla Colombo
- Paediatric Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Via Commenda 9, 20122, Milan, Italy.
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Lim SH, Ju HJ, Han JH, Lee JH, Lee WS, Bae JM, Lee S. Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19. JAMA Netw Open 2023; 6:e2336120. [PMID: 37801317 PMCID: PMC10559181 DOI: 10.1001/jamanetworkopen.2023.36120] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/22/2023] [Indexed: 10/07/2023] Open
Abstract
Importance Multiple cases of autoimmune and autoinflammatory diseases after COVID-19 have been reported. However, their incidences and risks have rarely been quantified. Objective To investigate the incidences and risks of autoimmune and autoinflammatory connective tissue disorders after COVID-19. Design, Setting, and Participants This was a retrospective population-based study conducted between October 8, 2020, and December 31, 2021, that used nationwide data from the Korea Disease Control and Prevention Agency COVID-19 National Health Insurance Service cohort and included individuals who received a diagnosis of COVID-19 via polymerase chain reaction testing and a control group with no evidence of COVID-19 identified from National Health Insurance Service of Korea cohort. Data analysis was conducted from September 2022 to August 2023. Exposures Receipt of diagnosis of COVID-19. Main Outcomes and Measures The primary outcomes were the incidence and risk of autoimmune and autoinflammatory connective tissue disorders following COVID-19. A total of 32 covariates, including demographics, socioeconomic statuses, lifestyle factors, and comorbidity profiles, were balanced through inverse probability weighting. The incidences and risks of autoimmune and autoinflammatory connective tissue disorders were compared between the groups using multivariable Cox proportional hazard analyses. Results A total of 354 527 individuals with COVID-19 (mean [SD] age, 52.24 [15.55] years; 179 041 women [50.50%]) and 6 134 940 controls (mean [SD] age, 52.05 [15.63] years; 3 074 573 women [50.12%]) were included. The risks of alopecia areata (adjusted hazard ratio [aHR], 1.12; 95% CI, 1.05-1.19), alopecia totalis (aHR, 1.74; 95% CI, 1.39-2.17), antineutrophil cytoplasmic antibody-associated vasculitis (aHR, 2.76; 95% CI, 1.64-4.65), Crohn disease (aHR, 1.68; 95% CI, 1.31-2.15), and sarcoidosis (aHR, 1.59; 95% CI, 1.00-2.52) were higher in the COVID-19 group. The risks of alopecia totalis, psoriasis, vitiligo, vasculitis, Crohn disease, ulcerative colitis, rheumatoid arthritis, adult-onset Still disease, Sjögren syndrome, ankylosing spondylitis, and sarcoidosis were associated with the severity of COVID-19. Conclusions and Relevance In this retrospective cohort study, COVID-19 was associated with a substantial risk for autoimmune and autoinflammatory connective tissue disorders, indicating that long-term management of patients with COVID-19 should include evaluation for such disorders.
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Affiliation(s)
- Sung Ha Lim
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Hyun Jeong Ju
- Department of Dermatology, St Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ju Hee Han
- Department of Dermatology, Seoul St Mary’s Hospital College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hae Lee
- Department of Dermatology, St Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Won-Soo Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jung Min Bae
- Department of Dermatology, St Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Solam Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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De Francesco MA, Piva S, Pellizzeri S, Signorini L, Fumarola B, Corbellini S, Piccinelli G, Simonetti F, Carta V, Mangeri L, Padovani M, Vecchiati D, Latronico N, Castelli F, Caruso A. Response to the Letter to the Editor on "Bacterial and fungal superinfections are detected at higher frequency in critically ill patients affected by SARS-CoV-2 infection than negative patients and are associated to a worse outcome". J Med Virol 2023; 95:e29192. [PMID: 37855669 DOI: 10.1002/jmv.29192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Maria Antonia De Francesco
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Anesthesia, Intensive Care and Emergency, Universita degli Studi di Brescia Dipartimento Specialita Medico-Chirurgiche Scienze Radiologiche e Sanita Pubblica, Brescia, Italy
| | - Simone Pellizzeri
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Liana Signorini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Division of Infectious and Tropical Diseases, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Benedetta Fumarola
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Division of Infectious and Tropical Diseases, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Silvia Corbellini
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Giorgio Piccinelli
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Francesca Simonetti
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Valentina Carta
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Lucia Mangeri
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Michela Padovani
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Daniela Vecchiati
- First Division of Anesthesiology and Intensive Care Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Anesthesia, Intensive Care and Emergency, Universita degli Studi di Brescia Dipartimento Specialita Medico-Chirurgiche Scienze Radiologiche e Sanita Pubblica, Brescia, Italy
| | - Francesco Castelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Division of Infectious and Tropical Diseases, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Arnaldo Caruso
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
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Hicks SD. Comparison of Symptom Duration Between Children With SARS-CoV-2 and Peers With Other Viral Illnesses During the COVID-19 Pandemic. Clin Pediatr (Phila) 2023; 62:1101-1108. [PMID: 36748919 PMCID: PMC9908512 DOI: 10.1177/00099228231152840] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Some children and young people (CYP) with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) experience persistent symptoms, commonly called "long COVID." It remains unclear whether symptoms of SARS-CoV-2 persist longer than those of other respiratory viruses, particularly in young children. This cross-sectional study involved 372 CYP (0-15 years) tested for SARS-CoV-2. Character and duration of symptoms (cough, runny nose, sore throat, rash, diarrhea, vomiting, sore muscles, fatigue, fever, loss of smell) were compared between CYP with a positive test (n = 100) and those with a negative test (n = 272), while controlling for medical/demographic covariates. The average duration of symptoms for CYP with a positive SARS-CoV-2 test (8.5 ± 10 days) did not differ from that of CYP with a negative test (7.2 ± 5 days, P = .71, d = 0.046). A positive SARS-CoV-2 test did not increase the risk (36/372, 10%) of symptoms persisting for ≥3 weeks (odds ratio = 0.96, 95% confidence interval = 0.45-2.0). These results suggest CYP with non-SARS-CoV-2 infections experience a similar duration of symptoms as peers with SARS-CoV-2 infection.
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Affiliation(s)
- Steven D. Hicks
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
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40
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Mallah N, Pardo-Seco J, Ares-Gómez S, López-Pérez LR, González-Pérez JM, Rosón B, Otero-Barrós MT, Durán-Parrondo C, Nartallo-Penas V, Mirás-Carballal S, Rodríguez-Tenreiro-Sánchez C, Rivero-Calle I, Gómez-Carballa A, Salas A, Martinón-Torres F. COVID-19 vaccine effectiveness in children by age groups. A population-based study in Galicia, Spain. Pediatr Allergy Immunol 2023; 34:e14037. [PMID: 37877845 DOI: 10.1111/pai.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/25/2023] [Accepted: 09/30/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Studies on vaccine effectiveness (VE) against COVID-19 in the pediatric population are outgoing. We aimed to quantify VE against SARS-CoV-2 in two pediatric age groups, 5-11 and 12-17-year-old, while considering vaccine type, SARS-CoV-2 variant, and duration of protection. METHODS A population-based test-negative control study was undertaken in Galicia, Spain. Children 5-11-year-old received the Comirnaty® (Pfizer, US) vaccine, while those aged 12-17-year-old received the Comirnaty® (Pfizer, US) or SpikeVax® (ModernaTX, Inc) vaccine. Participants were categorized into unvaccinated (0 doses or one dose with <14 days since vaccination), partially vaccinated (only one dose with ≥14 days, or two doses with <14 days after the second dose administration), and fully vaccinated (two doses with ≥14 days after the second injection). Adjusted odds ratios (OR) and their 95% confidence intervals (CI) were estimated using multiple logistic regression models. VE was calculated as (1-OR) * 100. Stratified and sensitivity analyses were performed. RESULTS In the fully vaccinated 5-11-year-old children, VE against the Omicron variant was 44.1% (95% CI: 38.2%-49.4%). In the fully vaccinated 12-17-year-old individuals, VE was 83.4% (95% CI: 81.2%-85.3%) against Delta and 74.8% (95% CI: 58.5%-84.9%) against Omicron. Comirnaty® and SpikeVax® vaccines showed a similar magnitude of VE against Delta [Comirnaty® VE: 81.9% (95% CI: 79.3%-84.1%) and SpikeVax® VE: 85.3% (95% CI: 81.9%-88.1%)]. Comirnaty® (Pfizer, US; VE: 79.7%; 95% CI: 50.7%-92.4%) showed a slightly higher magnitude of protection against Omicron than SpikeVax® (ModernaTX, Inc), yet with an overlapping CI (VE: 74.3%; 95% CI: 56.6%-84.9%). VE was maintained in all age subgroups in both pediatric populations, but it declined over time. CONCLUSIONS In Galicia, mRNA VE was moderate against SARS-CoV-2 infections in the 5-11-year-old populations, but high in older children. VE declined over time, suggesting a potential need for booster dose schedules.
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Affiliation(s)
- Narmeen Mallah
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Galicia, Spain
- WHO Collaborating Centre for Vaccine Safety, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine, University of Santiago de Compostela (USC), Santiago de Compostela, Galicia, Spain
| | - Jacobo Pardo-Seco
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Galicia, Spain
- WHO Collaborating Centre for Vaccine Safety, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Sonia Ares-Gómez
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Galicia, Spain
- WHO Collaborating Centre for Vaccine Safety, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis-Ricardo López-Pérez
- Subdirección de Sistemas y Tecnologías de la Información, Servizo Galego de Saude, Santiago de Compostela, Galicia, Spain
| | - Juan-Manuel González-Pérez
- Subdirección de Sistemas y Tecnologías de la Información, Servizo Galego de Saude, Santiago de Compostela, Galicia, Spain
| | - Benigno Rosón
- Subdirección de Sistemas y Tecnologías de la Información, Servizo Galego de Saude, Santiago de Compostela, Galicia, Spain
| | - María-Teresa Otero-Barrós
- Dirección Xeral de Saude Pública, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, Galicia, Spain
| | - Carmen Durán-Parrondo
- Dirección Xeral de Saude Pública, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, Galicia, Spain
| | - Victoria Nartallo-Penas
- Dirección Xeral de Saude Pública, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, Galicia, Spain
| | - Susana Mirás-Carballal
- Dirección Xeral de Saude Pública, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, Galicia, Spain
| | - Carmen Rodríguez-Tenreiro-Sánchez
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Galicia, Spain
- WHO Collaborating Centre for Vaccine Safety, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Irene Rivero-Calle
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Galicia, Spain
- WHO Collaborating Centre for Vaccine Safety, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario and University of Santiago de Compostela (USC), Santiago de Compostela, Galicia, Spain
| | - Alberto Gómez-Carballa
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Galicia, Spain
- WHO Collaborating Centre for Vaccine Safety, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Salas
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Galicia, Spain
- WHO Collaborating Centre for Vaccine Safety, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Unidade de Xenética, Facultade de Medicina, Instituto de Ciencias Forenses, Universidade de Santiago de Compostela (USC), Santiago de Compostela, Galicia, Spain
- GenPoB Research Group, Instituto de Investigación Sanitaria (IDIS), Hospital Clínico Universitario de Santiago, Servizo Galego de Saúde, Santiago de Compostela, Galicia, Spain
| | - Federico Martinón-Torres
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Galicia, Spain
- WHO Collaborating Centre for Vaccine Safety, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario and University of Santiago de Compostela (USC), Santiago de Compostela, Galicia, Spain
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Bozzola E, Caffarelli C, Santamaria F, Corsello G. Year 2022: exploring COVID-19 pandemic in children. Ital J Pediatr 2023; 49:128. [PMID: 37770981 PMCID: PMC10540415 DOI: 10.1186/s13052-023-01536-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023] Open
Abstract
COVID-19 pandemics is rapidly changing. In this article, we review progresses published in the Italian Journal of Pediatrics in 2022. More data on clinical pictures, prevention strategies and active management in children have been provided. The continued evolution of knowledge has driven transformations in the clinical approach to the disease and allowed key advancements in the care of children with COVID-19.
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Affiliation(s)
- Elena Bozzola
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Carlo Caffarelli
- Department of Medicine and Surgery, Clinica Pediatrica, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
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Moursi N, Tanofsky-Kraff M, Parker M, Loch L, Bloomer B, Te-Vazquez J, Nwosu E, Lazareva J, Yang SB, Turner S, Brady S, Yanovski J. Changes in Food Consumption, BMI, and Body Composition in Youth in the US during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6796. [PMID: 37754655 PMCID: PMC10531233 DOI: 10.3390/ijerph20186796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/23/2023] [Accepted: 08/27/2023] [Indexed: 09/28/2023]
Abstract
Rates of childhood overweight/obesity have risen for decades; however, data show the prevalence increased at a faster rate during the COVID-19 pandemic. Pandemic-associated increases in youth's body mass index (BMI; kg/m2) have been attributed to decreases in reported physical activity; few studies have examined changes in food intake. We therefore examined changes in total energy, nutrient consumption, BMI, BMIz, and adiposity longitudinally over 3 years, comparing healthy youth aged 8-17 years assessed twice prior to the pandemic, to youth seen once before and once during the pandemic. The total energy intake and percent macronutrient consumption were assessed using a standardized, laboratory-based, buffet-style meal. Height and weight were measured and adiposity was collected via dual energy X-ray absorptiometry. Generalized linear model univariate analyses investigated differences between groups. One-hundred-fifteen youth (15.6 + 2.8 years 47.8% female; 54.8% White) from the Washington D.C., Maryland, and Virginia greater metropolitan area participated. In this secondary analysis, neither changes in total energy intake (p = 0.52) nor changes in nutrient consumption were significantly different between the two groups (ps = 0.23-0.83). Likewise, changes in BMI, BMIz, and adiposity (ps = 0.95-0.25) did not differ by group. Further research should investigate food intake and body composition, comparing youth with and without overweight/obesity to better identify those at greatest risk of excess weight gain during the pandemic.
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Affiliation(s)
- Nasreen Moursi
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, Room 1-3330, Bethesda, MD 20892, USA; (N.M.); (M.P.); (L.L.); (B.B.); (J.T.-V.); (E.N.); (J.L.); (S.B.); (J.Y.)
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD 20814, USA
| | - Marian Tanofsky-Kraff
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, Room 1-3330, Bethesda, MD 20892, USA; (N.M.); (M.P.); (L.L.); (B.B.); (J.T.-V.); (E.N.); (J.L.); (S.B.); (J.Y.)
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD 20814, USA
| | - Megan Parker
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, Room 1-3330, Bethesda, MD 20892, USA; (N.M.); (M.P.); (L.L.); (B.B.); (J.T.-V.); (E.N.); (J.L.); (S.B.); (J.Y.)
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD 20814, USA
| | - Lucy Loch
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, Room 1-3330, Bethesda, MD 20892, USA; (N.M.); (M.P.); (L.L.); (B.B.); (J.T.-V.); (E.N.); (J.L.); (S.B.); (J.Y.)
| | - Bess Bloomer
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, Room 1-3330, Bethesda, MD 20892, USA; (N.M.); (M.P.); (L.L.); (B.B.); (J.T.-V.); (E.N.); (J.L.); (S.B.); (J.Y.)
| | - Jennifer Te-Vazquez
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, Room 1-3330, Bethesda, MD 20892, USA; (N.M.); (M.P.); (L.L.); (B.B.); (J.T.-V.); (E.N.); (J.L.); (S.B.); (J.Y.)
| | - Ejike Nwosu
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, Room 1-3330, Bethesda, MD 20892, USA; (N.M.); (M.P.); (L.L.); (B.B.); (J.T.-V.); (E.N.); (J.L.); (S.B.); (J.Y.)
| | - Julia Lazareva
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, Room 1-3330, Bethesda, MD 20892, USA; (N.M.); (M.P.); (L.L.); (B.B.); (J.T.-V.); (E.N.); (J.L.); (S.B.); (J.Y.)
| | - Shanna B. Yang
- Nutrition Department, NIH Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA; (S.B.Y.); (S.T.)
| | - Sara Turner
- Nutrition Department, NIH Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA; (S.B.Y.); (S.T.)
| | - Sheila Brady
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, Room 1-3330, Bethesda, MD 20892, USA; (N.M.); (M.P.); (L.L.); (B.B.); (J.T.-V.); (E.N.); (J.L.); (S.B.); (J.Y.)
| | - Jack Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, Room 1-3330, Bethesda, MD 20892, USA; (N.M.); (M.P.); (L.L.); (B.B.); (J.T.-V.); (E.N.); (J.L.); (S.B.); (J.Y.)
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Cai Z, Zhong J, Jiang Y, Zhang J. Bariatric surgery and COVID-19 outcomes: a systematic review and meta-analysis. Surg Obes Relat Dis 2023; 19:1058-1066. [PMID: 37149418 PMCID: PMC10010835 DOI: 10.1016/j.soard.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/28/2023] [Accepted: 02/24/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Obesity and its associated complications have a negative impact on human health. Metabolic and bariatric surgery (MBS) ameliorates a series of clinical manifestations associated with obesity. However, the overall efficacy of MBS on COVID-19 outcomes remains unclear. OBJECTIVES The objective of this article is to analyze the relationship between MBS and COVID-19 outcomes. SETTING A meta-analysis. METHODS The PubMed, Embase, Web of Science, and Cochrane Library databases were searched to retrieve the related articles from inception to December 2022. All original articles reporting MBS-confirmed SARS-CoV-2 infection were included. Outcomes including hospital admission, mortality, intensive care unit (ICU) admission, mechanical ventilation utilization, hemodialysis during admission, and hospital stay were selected. Meta-analysis with fixed or random-effect models was used and reported in terms of odds ratios (ORs) or weighted mean differences (WMDs) along with their 95% confidence intervals (CIs). Heterogeneity was assessed with the I2 test. Study quality was assessed using the Newcastle-Ottawa Scale. RESULTS A total of 10 clinical trials involving the investigation of 150,848 patients undergoing MBS interventions were included. Patients who underwent MBS had a lower risk of hospital admission (OR: .47, 95% CI: .34-.66, I2 = 0%), mortality (OR: .43, 95% CI: .28-.65, I2 = 63.6%), ICU admission (OR: .41, 95% CI: .21-.77, I2 = 0%), and mechanical ventilation (OR: .51, 95% CI: .35-.75, I2 = 56.2%) than those who did not undergo surgery, but MBS did not affect hemodialysis risk or COVID-19 infection rate. In addition, the length of hospital stay for patients with COVID-19 after MBS was significantly reduced (WMD: -1.81, 95% CI: -3.11-.52, I2 = 82.7%). CONCLUSIONS Our findings indicate that MBS is shown to improve COVID-19 outcomes, including hospital admission, mortality, ICU admission, mechanical ventilation, and hospital stay. Patients with obesity who have undergone MBS infected with COVID-19 will have better clinical outcomes than those without MBS.
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Affiliation(s)
- Zixin Cai
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jiaxin Zhong
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yingling Jiang
- Department of Metabolism and Endocrinology, The Affiliated Zhuzhou Hospital Xiangya Medical College CSU, Zhuzhou, Hunan, China
| | - Jingjing Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
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Bergeron HC, Hansen MR, Tripp RA. Interferons-Implications in the Immune Response to Respiratory Viruses. Microorganisms 2023; 11:2179. [PMID: 37764023 PMCID: PMC10535750 DOI: 10.3390/microorganisms11092179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/15/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Interferons (IFN) are an assemblage of signaling proteins made and released by various host cells in response to stimuli, including viruses. Respiratory syncytial virus (RSV), influenza virus, and SARS-CoV-2 are major causes of respiratory disease that induce or antagonize IFN responses depending on various factors. In this review, the role and function of type I, II, and III IFN responses to respiratory virus infections are considered. In addition, the role of the viral proteins in modifying anti-viral immunity is noted, as are the specific IFN responses that underly the correlates of immunity and protection from disease.
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Affiliation(s)
| | | | - Ralph A. Tripp
- Department of Infectious Diseases, University of Georgia College of Veterinary Medicine, Athens, GA 30605, USA; (H.C.B.); (M.R.H.)
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Tomezzoli E, D'Ecclesiis O, Raimondi S, Pravettoni G, Cammarata G, Testa G, Bellerba F, Gnagnarella P, Iannuzzo ML, Sartorio A, Sasso C, Ricci D, Marazzi N, Galli F, Gandini S. Sports activity limitation during the COVID-19 pandemic in young Italian athletes: impact on mental health in children, adolescents, and young adults. Front Public Health 2023; 11:1237443. [PMID: 37637799 PMCID: PMC10448519 DOI: 10.3389/fpubh.2023.1237443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction The closure of sports centres was implemented as a preventive measure to mitigate the transmission of SARS-CoV-2. Given the observed global decline in physical activity and concurrent rise in sedentary behaviour, even among younger age groups, a retrospective cross-sectional study was undertaken to evaluate the effects of this measure on mental health in children, adolescents, and young adults during the initial phases of the COVID-19 pandemic. Methods A total of 1,717 non-professional athletes (age range: 6-25; 53.9% males, 44.6% females) completed an online questionnaire including widely used and validated measures for mental health assessment (SDQ and PGWB-S) and questions regarding sociodemographic characteristics (such as gender), physical activity, and screen time. The association between mental health and sociodemographic characteristics, physical activity, and screen time was evaluated by using univariate and multivariable logistic regression models. Results In children and adolescents, the incidence of psychological difficulties was associated with not being physically active (OR = 1.49; 95% CI: 1.09, 2.07; p = 0.015). Engaging in physical activity during the period of closures, particularly if more than twice a week, was significantly associated with less psychological difficulties for children/adolescents (OR = 0.54; 95% CI: 0.35, 0.82; p = 0.004) and psychological symptoms (i.e., psychological well-being lower than the median) for youth/young adults (OR = 0.25; 95% CI: 0.14, 0.45; p < 0.001). More psychological difficulties were also found in males for children and adolescents (OR = 1.37; 95% CI: 1.06, 1.79; p = 0.018). However, young adult males showed less psychological symptoms than females (OR = 0.35; 95% CI: 0.22, 0.55; p = 0.001). Additionally, a greater amount of screen time was associated with a higher incidence of psychological symptoms in the whole sample. Conclusions Our results confirm the positive impact of physical activity on mental health during the COVID-19 pandemic among younger age groups. They also provide valuable insights into the risk-benefit relationship of interrupting sports activities as a preventive measure for infectious diseases.
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Affiliation(s)
- Elisa Tomezzoli
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Oriana D'Ecclesiis
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Sara Raimondi
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giulio Cammarata
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | | | - Federica Bellerba
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Patrizia Gnagnarella
- Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Maria Luisa Iannuzzo
- AULSS 9 Scaligera, Dipartimento di Prevenzione, UOC Medicina Legale, Verona, Italy
| | - Alessandro Sartorio
- Experimental Laboratory for Auxo-endocrinological Research, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Clementina Sasso
- Istituto Nazionale di Astrofisica (INAF)-Capodimonte Astronomical Observatory, Naples, Italy
| | - Dorotea Ricci
- ARES-ODV Associazione Regionale Emergenza Sanitaria, Ancona, Italy
| | - Nicoletta Marazzi
- Experimental Laboratory for Auxo-endocrinological Research, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Federica Galli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Sara Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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Soriano-Arandes A, Brett A, Buonsenso D, Emilsson L, de la Fuente Garcia I, Gkentzi D, Helve O, Kepp KP, Mossberg M, Muka T, Munro A, Papan C, Perramon-Malavez A, Schaltz-Buchholzer F, Smeesters PR, Zimmermann P. Policies on children and schools during the SARS-CoV-2 pandemic in Western Europe. Front Public Health 2023; 11:1175444. [PMID: 37564427 PMCID: PMC10411527 DOI: 10.3389/fpubh.2023.1175444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/26/2023] [Indexed: 08/12/2023] Open
Abstract
During the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mitigation policies for children have been a topic of considerable uncertainty and debate. Although some children have co-morbidities which increase their risk for severe coronavirus disease (COVID-19), and complications such as multisystem inflammatory syndrome and long COVID, most children only get mild COVID-19. On the other hand, consistent evidence shows that mass mitigation measures had enormous adverse impacts on children. A central question can thus be posed: What amount of mitigation should children bear, in response to a disease that is disproportionally affecting older people? In this review, we analyze the distinct child versus adult epidemiology, policies, mitigation trade-offs and outcomes in children in Western Europe. The highly heterogenous European policies applied to children compared to adults did not lead to significant measurable differences in outcomes. Remarkably, the relative epidemiological importance of transmission from school-age children to other age groups remains uncertain, with current evidence suggesting that schools often follow, rather than lead, community transmission. Important learning points for future pandemics are summarized.
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Affiliation(s)
- Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ana Brett
- Infectious Diseases Unit and Emergency Service, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Milan, Italy
| | - Louise Emilsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Isabel de la Fuente Garcia
- Pediatric Infectious Diseases, National Pediatric Center, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Despoina Gkentzi
- Department of Paediatrics, Patras Medical School, Patras, Greece
| | - Otto Helve
- Department of Health Security, Institute for Health and Welfare, Helsinki, Finland
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Kasper P. Kepp
- Section of Biophysical and Biomedicinal Chemistry, DTU Chemistry, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Maria Mossberg
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Epistudia, Bern, Switzerland
| | - Alasdair Munro
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Faculty of Medicine, Institute of Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Cihan Papan
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Aida Perramon-Malavez
- Computational Biology and Complex Systems (BIOCOM-SC) Group, Department of Physics, Universitat Politècnica de Catalunya (UPC·BarcelonaTech), Barcelona, Spain
| | | | - Pierre R. Smeesters
- Department of Pediatrics, University Hospital Brussels, Academic Children’s Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Petra Zimmermann
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, Fribourg Hospital, Fribourg, Switzerland
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Fotea S, Ghiciuc CM, Stefanescu G, Cianga AL, Mihai CM, Lupu A, Butnariu LI, Starcea IM, Salaru DL, Mocanu A, Chisnoiu T, Thet AA, Miron L, Lupu VV. Pediatric COVID-19 and Diabetes: An Investigation into the Intersection of Two Pandemics. Diagnostics (Basel) 2023; 13:2436. [PMID: 37510181 PMCID: PMC10378192 DOI: 10.3390/diagnostics13142436] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a complex infectious disease caused by the SARS-CoV-2 virus, and it currently represents a worldwide public health emergency. The pediatric population is less prone to develop severe COVID-19 infection, but children presenting underlying medical conditions, such as diabetes mellitus, are thought to be at increased risk of developing more severe forms of COVID-19. Diabetic children face new challenges when infected with SARS-CoV-2. On one hand, the glycemic values become substantially more difficult to manage as COVID-19 is a predisposing factor for hyperglycemia. On the other hand, alongside other risk factors, high glycemic values are incriminated in modulating immune and inflammatory responses, leading to potentially severe COVID-19 cases in the pediatric population. Also, there are hypotheses of SARS-CoV-2 being diabetogenic itself, but this information is still to be confirmed. Furthermore, it is reported that there was a noticeable increase in the number of cases of new-onset type 2 diabetes among the pediatric population, and the complications in these patients with COVID-19 include the risk of developing autoimmune diseases under the influence of stress. Additionally, children with diabetes mellitus are confronted with lifestyle changes dictated by the pandemic, which can potentially lead to the onset or exacerbation of a potential underlying anxiety disorder or depression. Since the literature contains a series of unknowns related to the impact of COVID-19 in both types of diabetes in children, the purpose of our work is to bring together the data obtained so far and to identify potential knowledge gaps and areas for future investigation regarding COVID-19 and the onset of diabetes type 1 or type 2 among the pediatric population.
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Affiliation(s)
- Silvia Fotea
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
| | - Cristina Mihaela Ghiciuc
- Pharmacology, Clinical Pharmacology and Algeziology, Department of Morpho-Functional Sciences II, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Gabriela Stefanescu
- I-st Medical Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Anca Lavinia Cianga
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristina Maria Mihai
- Pediatrics, Faculty of General Medicine, Ovidius University, 900470 Constanta, Romania
| | - Ancuta Lupu
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Lacramioara Ionela Butnariu
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Iuliana Magdalena Starcea
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Delia Lidia Salaru
- Faculty of General Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Adriana Mocanu
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Tatiana Chisnoiu
- Pediatrics, Faculty of General Medicine, Ovidius University, 900470 Constanta, Romania
| | - Aye Aung Thet
- Faculty of General Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Lucian Miron
- III-rd Medical Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Vasile Valeriu Lupu
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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Sirgi Y, Stanojevic M, Ahn J, Yazigi N, Kaufman S, Khan K, Vitola B, Matsumoto C, Kroemer A, Fishbein T, Ekong UD. COVID-19 Disease in Pediatric Solid Organ Transplantation from Alpha to Omicron: A High Monocyte Count in the Preceding Three Months Portends a Risk for Severe Disease. Viruses 2023; 15:1559. [PMID: 37515245 PMCID: PMC10383409 DOI: 10.3390/v15071559] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
IMPORTANCE Planning for future resurgences in SARS-CoV-2 infection is necessary for providers who care for immunocompromised patients. OBJECTIVE to determine factors associated with COVID-19 disease severity in immunosuppressed children. DESIGN a case series of children with solid organ transplants diagnosed with SARS-CoV-2 infection between 15 March 2020 and 31 March 2023. SETTING a single pediatric transplant center. PARTICIPANTS all children with a composite transplant (liver, pancreas, intestine), isolated intestine transplant (IT), isolated liver transplant LT), or simultaneous liver kidney transplant (SLK) with a positive PCR for SARS-CoV-2. EXPOSURE SARS-CoV-2 infection. MAIN OUTCOME AND MEASURES We hypothesized that children on the most immunosuppression, defined by the number of immunosuppressive medications and usage of steroids, would have the most severe disease course and that differential white blood cell count in the months preceding infection would be associated with likelihood of having severe disease. The hypothesis being tested was formulated during data collection. The primary study outcome measurement was disease severity defined using WHO criteria. RESULTS 77 children (50 LT, 24 intestine, 3 SLK) were infected with SARS-CoV-2, 57.4 months from transplant (IQR 19.7-87.2). 17% were ≤1 year post transplant at infection. 55% were male, 58% were symptomatic and ~29% had severe disease. A high absolute lymphocyte count at diagnosis decreased the odds of having severe COVID-19 disease (OR 0.29; CI 0.11-0.60; p = 0.004). Conversely, patients with a high absolute monocyte count in the three months preceding infection had increased odds of having severe disease (OR 30.49; CI 1.68-1027.77; p = 0.033). Steroid use, higher tacrolimus level, and number of immunosuppressive medications at infection did not increase the odds of having severe disease. CONCLUSIONS AND RELEVANCE The significance of a high monocyte count as predictor of severe disease potentially confirms the importance of monocytic inflammasome-driven inflammation in COVID-19 pathogenesis. Our data do not support reducing immunosuppression in the setting of infection. Our observations may have important ramifications in resource management as vaccine- and infection-induced immunity wanes.
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Affiliation(s)
- Yasmina Sirgi
- Department of Surgery, Georgetown University Medical School, Washington, DC 20007, USA
| | - Maja Stanojevic
- Department of Pediatrics, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC 20007, USA
| | - Nada Yazigi
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - Stuart Kaufman
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - Khalid Khan
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - Bernadette Vitola
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - Cal Matsumoto
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - Alexander Kroemer
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - Thomas Fishbein
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - Udeme D Ekong
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC 20007, USA
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Emeksiz HC, Hepokur MN, Şahin SE, Şirvan BN, Çiçek B, Önder A, Yıldız M, Aksakal DK, Bideci A, Ovalı HF, İşman F. Immunogenicity, safety and clinical outcomes of the SARS-CoV-2 BNT162b2 vaccine in adolescents with type 1 diabetes. Front Pediatr 2023; 11:1191706. [PMID: 37435175 PMCID: PMC10331611 DOI: 10.3389/fped.2023.1191706] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction The mRNA-based BNT162b2 (Pfizer-BioNTech) vaccine has been shown to elicit robust systemic immune response and confer substantial protection against the severe coronavirus disease (COVID-19), with a favorable safety profile in adolescents. However, no data exist regarding immunogenicity, reactogenicity and clinical outcomes of COVID-19 vaccines in adolescents with type 1 diabetes (T1D). In this prospective observational cohort study, we examined the humoral immune responses and side effects induced by the BNT162b2 vaccine, as well as, the rate and symptomatology of laboratory-confirmed COVID-19 vaccine breakthrough infections after completion of dual-dose BNT162b2 vaccination in adolescents with T1D and compared their data with those of healthy control adolescents. The new data obtained after the vaccination of adolescents with T1D could guide their further COVID-19 vaccination schedule. Methods A total of 132 adolescents with T1D and 71 controls were enrolled in the study, of whom 81 COVID-19 infection-naive adolescents with T1D (patient group) and 40 COVID-19 infection-naive controls (control group) were eligible for the final analysis. The response of participants to the BNT162b2 vaccine was assessed by measuring their serum IgG antibodies to the spike protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 4-6 weeks after the receipt of first and second vaccine doses. Data about the adverse events of the vaccine was collected after the receipt of each vaccine dose. The rate of COVID-19 vaccine breakthrough infections was evaluated in the 6-month period following second vaccination. Results After vaccinations, adolescents with T1D and controls exhibited similar, highly robust increments in anti-SARS-CoV-2 IgG titers. All the participants in the patient and control groups developed anti-SARS-CoV-2 IgG titers over 1,050 AU/ml after the second vaccine dose which is associated with a neutralizing effect. None of the participants experienced severe adverse events. The rate of breakthrough infections in the patient group was similar to that in the control group. Clinical symptomatology was mild in all cases. Conclusion Our findings suggest that two-dose BNT162b2 vaccine administered to adolescents with T1D elicits robust humoral immune response, with a favorable safety profile and can provide protection against severe SARS-CoV-2 infection similar to that in healthy adolescents.
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Affiliation(s)
- Hamdi Cihan Emeksiz
- Department of Pediatric Endocrinology, Professor Doctor Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Türkiye
| | - Merve Nur Hepokur
- Department of Pediatric Endocrinology, Professor Doctor Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Türkiye
| | - Sibel Ergin Şahin
- Department of Pediatric Endocrinology, Professor Doctor Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Türkiye
| | - Banu Nursoy Şirvan
- Department of Pediatric Endocrinology, Professor Doctor Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Türkiye
| | - Burçin Çiçek
- Department of Pediatric Endocrinology, Professor Doctor Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Türkiye
| | - Aşan Önder
- Department of Pediatric Endocrinology, Professor Doctor Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Türkiye
| | - Metin Yıldız
- Department of Pediatric Endocrinology, Professor Doctor Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Türkiye
| | - Derya Karaman Aksakal
- Department of Pediatric Endocrinology, Professor Doctor Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Türkiye
| | - Aysun Bideci
- Department of Pediatric Endocrinology, Gazi University Hospital, Ankara, Türkiye
| | - Hüsnü Fahri Ovalı
- Department of Pediatrics, Professor Doctor Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Türkiye
| | - Ferruh İşman
- Department of Biochemistry, Professor Doctor Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Türkiye
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Bitar R, Elghoudi AA, Rawat D, Azaz A, Miqdady M, Narchi H. COVID-19-induced liver injury in infants, children, and adolescents. World J Clin Pediatr 2023; 12:57-67. [PMID: 37342451 PMCID: PMC10278079 DOI: 10.5409/wjcp.v12.i3.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/07/2022] [Accepted: 03/17/2023] [Indexed: 06/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) typically presents with fever and respiratory symptoms in children. Most children develop an asymptomatic and mild illness, with a minority requiring specialist medical care. Gastrointestinal manifestations and liver injury can also occur in children following infection. The mechanisms of liver injury may include infection following direct viral hepatic tissue invasion, immune response, or medication effects. Affected children might develop mild liver dysfunction which has a benign course in most children with no pre-existing liver disease. However, the presence of non-alcoholic fatty liver disease or other pre-existing chronic liver disorders is associated with a higher risk of developing severe COVID-19 illness with poor outcomes. On the other hand, the presence of liver manifestations is associated with the severity of COVID-19 disease and is considered an independent prognostic factor. Respiratory, hemodynamic, and nutritional supportive therapies are the mainstay of management. Vaccination of children at increased risk of developing severe COVID-19 disease is indicated. This review describes the liver manifestations in children with COVID-19, detailing its epidemiology, basic mechanisms, clinical expression, management, and prognosis in those with and without pre-existing liver disease and also children who have had earlier liver transplantation.
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Affiliation(s)
- Rana Bitar
- Division of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Ahmed A Elghoudi
- Department of Pediatric, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- Department of Pediatric, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - David Rawat
- Division of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Amer Azaz
- Division of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Mohamad Miqdady
- Division of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Hassib Narchi
- Department of Pediatric, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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